Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide

Excerpt

Recently, it has been reported [1, 2] that a serious adverse reaction called nephrogenic systemic fibrosis (NSF) may occur after exposure to the extracellular nonionic low osmolar gadolinium-based contrast agent gadodiamide (Omniscan^®, GE Health Diagnostic, Amersham, United Kingdom). Nephrogenic systemic fibrosis was recognized in 1997 in California [3]. The typical patient is middle-aged and has end-stage renal disease (ESRD) [4]. Most patients, but not all, are on regular dialysis treatment. The typical course begins with subacute swelling of distal parts of the extremities followed during subsequent weeks by severe skin induration and sometimes anatomical extension involving thighs, antebrachium, and lower abdomen. The skin induration may be aggressive and associated with constant pain, muscle restlessness, and loss of skin flexibility. In some cases, NSF leads to serious physical disability including wheelchair requirement. NSF was initially observed in and thought to solely affect the skin—therefore, it was initially called nephrogenic fibrosing dermopathy—but it is now known that several organs such as liver, lungs, muscles and heart may be involved. Organ involvement may explain the suspected increased mortality of NSF patients [4]. …