NSF after Gadovist exposure: a case report and hypothesis of NSF development

• Published in: Nephrology, dialysis, transplantation Vol. 24; no. 12; pp. 3882 - 3884
• Main Authors: Wollanka, Helmut, Weidenmaier, Werner, Giersig, Cecylia
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.12.2009
• Subjects: Abdomen; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; case report; Contrast Media - adverse effects; Emergency and intensive care: renal failure. Dialysis management; FGF23-Klotho axis; Humans; hypothesis of NSF development; Intensive care medicine; macrocyclical gadolinium-based contrast media; Male; Medical sciences; Nephrogenic Fibrosing Dermopathy - chemically induced; NSF; Organometallic Compounds - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; NSF; case report; FGF23-Klotho axis; macrocyclical gadolinium-based contrast media; hypothesis of NSF development; Kidney disease; Urinary system disease; Hemodialysis; Gadolinium; Case study; Extrarenal dialysis; Renal failure; Contrast media
• DOI: 10.1093/ndt/gfp494
• ISSN: 0931-0509

So far no cases of nephrogenic systemic fibrosis (NSF) have been published on macrocyclical gadolinium-based contrast media (Gd-CM), assumed as low NSF risk CM due to their complex stability. In our haemodialysis-dependent patient, the first symptoms indicating NSF appeared about 16 months after the exposure to Gadovist, a macrocyclical Gd-CM, and 1 month after x-ray angiography with iodinated CM (Ultravist). This indicates that in addition to excretory renal failure and Gd-CM exposure, the loss of biosynthetic renal function could be essential for NSF development. A hypothesis of possible pathways involved in the development of NSF is presented.