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Abstract
Background Although nephrogenic systemic fibrosis (NSF) affects the use of gadolinium-based contrast agents (GBCAs) in MRI, there continues to be limited knowledge because of the small number of patients with NSF. Purpose To perform a systematic review of NSF. Materials and Methods PubMed database was searched by using the term "Nephrogenic systemic fibrosis" from January 2000 to February 2019. Articles reporting details on individual patients with NSF diagnosis on the basis of both clinical presentations and biopsy confirmation were included. Data were pooled and authors were contacted for clarifications. Rates of NSF were compared through 2008 versus after 2008 and for group I versus group II GBCAs, assuming equal market share. Results Included were 639 patients from 173 articles. Data regarding sex were found for 295 men and 254 women. Age at NSF symptom onset was reported for 177 patients (mean, 49 years ± 16 [standard deviation]; age range, 6-87 years). There were 529 patients with documented exposure to GBCAs including gadodiamide (n = 307), gadopentetate dimeglumine (n = 49), gadoversetamide (n = 6), gadobutrol (n = 1), gadobenate dimeglumine (n = 1), multiple (n = 41), and unknown (n = 120). Among patients with previous exposure, only seven patients were administered GBCA after 2008, yielding a lower rate of NSF after 2008 (P < .001). There were motion limitations in 70.8% (296 of 418) of patients, indicating a more serious debilitation. Associated factors reported for NSF included exposure to GBCA group I (P < .001), dialysis, proinflammatory conditions, hyperphosphatemia, β-blockers, and epoetin. For 341 patients with follow-up, 12 patients were cured and 72 patients partially improved including one during pregnancy. Among those 84 patients reported as cured or improved, in 34 patients cure or improvement occurred after renal function restoration. Four deaths were attributed to NSF. Conclusion Although 639 patients with biopsy-confirmed nephrogenic systemic fibrosis were reported, only seven were after gadolinium-based contrast agent exposure after 2008, indicating that regulatory actions and practice changes have been effective preventive measures. Improvement and sometimes cure with renal function restoration are now possible. © RSNA, 2019 See also the editorial by Davenport in this issue.
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Affiliation(s)
- Hanieh Attari
- From the Department of Radiology, Weill Cornell Medical College & New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022 (H.A., Y.Z., M.R.P.); Department of Radiology, Wayne State University/Detroit Medical Center, Detroit, Mich (Y.C.); Department of Children and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark (T.R.E.); and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Yan Cao
- From the Department of Radiology, Weill Cornell Medical College & New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022 (H.A., Y.Z., M.R.P.); Department of Radiology, Wayne State University/Detroit Medical Center, Detroit, Mich (Y.C.); Department of Children and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark (T.R.E.); and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Tina R Elmholdt
- From the Department of Radiology, Weill Cornell Medical College & New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022 (H.A., Y.Z., M.R.P.); Department of Radiology, Wayne State University/Detroit Medical Center, Detroit, Mich (Y.C.); Department of Children and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark (T.R.E.); and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Yize Zhao
- From the Department of Radiology, Weill Cornell Medical College & New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022 (H.A., Y.Z., M.R.P.); Department of Radiology, Wayne State University/Detroit Medical Center, Detroit, Mich (Y.C.); Department of Children and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark (T.R.E.); and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Martin R Prince
- From the Department of Radiology, Weill Cornell Medical College & New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022 (H.A., Y.Z., M.R.P.); Department of Radiology, Wayne State University/Detroit Medical Center, Detroit, Mich (Y.C.); Department of Children and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark (T.R.E.); and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
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Moshiri AS, Elenitsas R, Gaddis KJ, Werth VP, Nguyen CV, Pearson D, Rubin AI. Launching lollipops? Perforating osteoma cutis in nephrogenic systemic fibrosis. J Cutan Pathol 2019; 46:467-470. [DOI: 10.1111/cup.13409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/14/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ata S. Moshiri
- Department of DermatologyHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Rosalie Elenitsas
- Department of DermatologyHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Kevin J. Gaddis
- Department of DermatologyUniversity of Minnesota Minneapolis Minnesota
| | - Victoria P. Werth
- Department of DermatologyHospital of the University of Pennsylvania Philadelphia Pennsylvania
- Department of Dermatology, Corporal Michael J. Crescenz VA Medical Center Philadelphia, Pennsylvania
| | - Cuong V. Nguyen
- Department of DermatologyHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - David Pearson
- Department of DermatologyUniversity of Minnesota Minneapolis Minnesota
| | - Adam I. Rubin
- Department of DermatologyHospital of the University of Pennsylvania Philadelphia Pennsylvania
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Abstract
Gadolinium-based contrast agents (GBCAs), once believed to be safe for patients with renal disease, have been strongly associated with nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder that predominantly afflicts individuals with advanced renal dysfunction. We provide a historical perspective on the appearance and disappearance of NSF, including its initial recognition as a discrete clinical entity, its association with GBCA exposure, and the data supporting a causative relationship between GBCA exposure and NSF. On the basis of this body of evidence, we propose that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease. Use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this population has almost completely eradicated new cases of this debilitating condition. Emerging antifibrotic therapies may be useful for patients who suffer from GIF.
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Affiliation(s)
- Derrick J Todd
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts 01605;
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