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On May 27, 2015, JAMA Dermatology published a Case Report by Larson et al that described a biopsy-confirmed case of “Nephrogenic Systemic Fibrosis Manifesting a Decade after Exposure to Gadolinium”. According to the report, a long-term hemodialysis patient was exposed to a gadolinium-based contrast agent several times between 1998 and 2004 during magnetic resonance angiography (MRA) of his abdominal vessels and arteriovenous fistula. Ten years later, in 2014, he developed new dermal papules and plaques. The diagnosis of NSF was made based on the findings of a biopsy of affected skin which showed thickening of collagen, CD34+ spindle cells, and increased mucin in the dermis. (Information about the agent(s) and dosages are not provided).
Prior to this case, the authors noted that the longest documented time after exposure to gadolinium to NSF manifestation was 3 ½ years.
This case shows that even in patients with severe renal disease retained gadolinium can take many years before causing “visible” evidence of a problem. The authors concluded that, “Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease”. (more…)
A novel approach to diagnosing Nephrogenic Systemic Fibrosis, better known as NSF, was recently published by Birka et al in Analytical Chemistry. Birka and his colleagues used the combination of inductively coupled plasma mass spectrometry (ICP-MS), laser ablation (LA) ICP-MS for elemental bioimaging, and hydrophilic interaction liquid chromatography (HILIC) ICP-MS for speciation analysis, which allowed them to diagnose a case of NSF. While the article, Diagnosis of Nephrogenic Systemic Fibrosis by means of Elemental Bioimaging and Speciation Analysis, is very scientific in its details, there are facts to be learned by patients as well.
Skin biopsy specimens of NSF patients that were investigated by various techniques, found the presence of gadolinium deposits were mainly in the deeper regions of the subcutis (fat and connective tissue). A correlation of gadolinium with calcium, sodium, and phosphorous was observed in all cases.
The case report in this study involved a young woman who exhibited characteristic symptoms of NSF that began in 2011. Her clinical history included renal failure and kidney transplants from living donors in 2004 and 2006; the authors noted that she still has dialysis-dependent kidney insufficiency. The patient had an MRI in 2002 with Magnevist (Gd-DTPA) and in 2005 with ProHance (Gd-HP-DO3A). (more…)
On November 12, 2014, an article was published online about a new condition called Gadolinium-Associated Plaques or GAP. The JAMA Dermatology article by Gathings, Reddy, Santa Cruz, and Brodell is titled, “Case Report/Case Series, Gadolinium-Associated Plaques – A New, Distinctive Clinical Entity”. The full-article is not freely available online at this time; however, the abstract can be found at http://dx.doi.org/10.1001/jamadermatol.2014.2660.
While this case series reports on only 2 patients, its findings are especially significant for patients with normal renal (kidney) function. Both patients had erythematous plaques which were determined to be sclerotic bodies in various stages of calcification. Previously these sclerotic bodies were thought to be associated with NSF (Nephrogenic Systemic Fibrosis) in patients with chronic renal disease after exposure to a Gadolinium-based Contrast Agent (GBCA). The significance of this case series is that neither patient had NSF; while one patient did have renal disease, the other patient did not. (more…)
Suspecting or discovering that you are Gadolinium Toxic can be a scary time and you may not know what to do. And if you are like others, the journey to manage your condition will last for an extended period of time.
The 11 Tips we present here will make understanding and managing your condition an easier task. (more…)