Nephrogenic systemic fibrosis

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Brief Notes

In earlier years, magnetic resonance imaging was considered as a safe modality of imaging in those with renal failure because it did not have the potential for contrast induced nephropathy which could occur with radiocontrast imaging. But when nephrogenic systemic fibrosis was described as an association with gadolinium based contrast agents, more caution was called for in magnetic resonance imaging in severe renal dysfunction. This led to less use of gadolinium enhanced magnetic resonance imaging in patients with severe renal failure who are at risk of nephrogenic systemic fibrosis. This has led to virtual elimination of new cases of nephrogenic systemic fibrosis according to Zou Z et al [1] who reviewed three hundred and seventy cases from ninety eight published articles.
Zou Z et al have also come out with some useful suggestions to reduce the potential risk:

  • Limiting the dose of gadolinium based contrast agent to less than 0.1 millimoles per kilogram body weight
  • Dialysing them quickly after contrast administration
  • Delaying contrast administration till recovery of renal function in those with acute renal failure
  • Avoiding non linear gadolinium based contrast agents in those with renal failure, more so when there are pro inflammatory conditions associated

Reference

  1. Zou Z et al. Nephrogenic Systemic Fibrosis. Review of 370 Biopsy-Confirmed Cases. JACC Cardiovasc Imaging. 2011; 4:1206-1216.