In 2006, a connection was made between Gadolinium-based Contrast Agents (GBCAs) administered for contrast-enhanced MRIs and Nephrogenic Systemic Fibrosis (NSF). NSF is a potentially fatal disease that has been diagnosed almost exclusively in patients with end-stage renal disease (ESRD). Prolonged excretion times and the instability of the GBCA results in the toxic gadolinium ion separating from the ligand and remaining in the body, where it can cause extensive fibrosis and calcification of tissues. Aside from their role in NSF, GBCAs have historically been considered safe. Patients with normal renal function are told that the contrast agent will be out of their body within a few days. We first reported evidence of long-term gadolinium retention in October, 2013. In December of 2013, Kanda published the first paper to report evidence of gadolinium deposition in the brains of patients with normal renal function. Although more studies are being conducted, very little is known about long-term retention of gadolinium in patients with normal renal function.
In this study, 70 cases are analyzed involving 120 tests for gadolinium in 24-hour urine collections, performed from as few as 4 days to as long as 10 years after contrast administration. The subjects for the analysis are patients who believe they have symptoms of gadolinium toxicity caused by their contrast-enhanced MRIs. In cases where urine tests were performed within the 3 months following contrast administration, none had a result that was within the reference range used by Mayo Clinic Laboratories. Cases with multiple contrast MRIs show elevated gadolinium levels for longer time periods than those with a single contrast administration. Overall, the results of this study conflict with the published clearance times of GBCAs and indicate levels of increased chronic toxicity from multiple contrast administrations. Both of these results have the potential to produce Gadolinium Toxicity with NSF-like symptoms in patients with normal renal function. Further investigation by researchers, GBCA manufacturers, and licensing agencies is warranted.
No attempt is made to determine what, if any, level of gadolinium is safe to remain in the body. The authors, who are study participants, take sole responsibility for the content of this document.
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