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Gadolinium Contrast Dyes And NSF/NFD

Apr 27, 2008
Nephrogenic Systemic Fibrosis (NSF) - also known as Nephrogenic Fibrosing Dermopathy, or NFD - is a severely debilitating condition that has been diagnosed in people with kidney disease following exposure to gadolinium contrast dyes used in magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). NSF/NFD is characterized by a hardening of the skin, as well as the excessive formation of connective tissue in the internal organs. As of yet, there is no cure for NSF/NFD, though various therapies can provide some relief, and kidney transplants have been known to slow the disease's progression. Unfortunately, some cases of NSF/NFD will result in death.

The first known diagnosis of NSF/NFD occurred in 1997, but it wasn't until September 2000 that details of the disease were published in the medical journal Lancet. NSF/NFD has only been seen in people with pre-existing kidney conditions who have undergone MRIs or MRAs involving the use of gadolinium contrast agents. The first gadolinium contrast agents were approved for use in the United States in the 1980s. These drugs have never been approved for MRA procedures, but have been widely used for this purpose. Currently, there are five gadolinium contrast dyes approved for use in the United States: Omniscan by GE Healthcare; OptiMARK by Mallinckrodt/Tyco Healthcare; Magnevist by Bayer/Schering AG/Berlex; ProHance by Bracco Diagnostics and MultiHance by Bracco Diagnostics.

Gadolinium contrast dyes became the preferred agents for MRI procedures because it was thought they were safer than older iodine-based dyes. While gadolinium in its natural state is highly toxic, the manufacturing process - where gadolinium is bound to a chelate - makes it safe for use as a contrast agent. However, gadolinium must be eliminated from the body through the kidneys, and people with kidney disease may not be able to do this. For this reason, it is recommended that if a kidney patient must have a procedure that involves a gadolinium contrast dye, they undergo a dialysis treatment shortly afterwards. While this may help eliminate gadolinium from their system, dialysis has not been proven to prevent all cases of NSF/NFD.

NSF/NFD can appear within days or months of exposure to gadolinium contrast dyes, and some patients have developed the disorder after only one exposure, while others have had multiple doses of gadolinium contrast dyes prior to onset. NSF/NFD is a progressive disease, and presents with the following symptoms:

* Tightening and swelling of the skin
* Thickening of the skin around the joints, restricting movement
* Extremely hard or rough skin has the texture of an orange peel
* Red or dark patches of skin
* Burning, itching, and/or sharp pains in affected areas
* Symmetrical skin lesions
* Muscle weakness
* Deep bone pain in the hips and ribs
* Calcification of soft tissues
* Yellow plaques near the eyes

It can take several years for all of the symptoms associated with NSF/NFD to appear. However, some patients have a form of NSF/NFD that progresses so quickly that they often die of complications brought on by the disease.

There is no cure for NSF/NFD, although the restoration of kidney function - usually through a kidney transplant - can improve and sometimes eliminate symptoms. Photopheresis, a treatment where blood is temporarily removed from the body and exposed to ultraviolet light before being re-injected into the patient, has been shown to help in some cases of NSF. However, the treatment is expensive - costing about $8000 every two weeks. Other treatments that have been shown to ease NSF/NFD symptoms include oral steroids, topical Dovonex, Plasmapheresis,* Thalidomide,* Pentoxifylline, Plaquenil and physical therapy. Some of these treatments have serious side effects, and unfortunately, not all patients will respond to them.

Any kidney patient who has been exposed to gadolinium contrast dyes needs to be aware that they are at risk for NSF/NFD, and should understand its signs. If they experience any symptoms typical of NSF/NFD, it is important to contact a doctor immediately for a skin biopsy.

For more information on gadolinium and NSF/NFD, please visit www.the-feed-store.com, where you can access a variety of articles on this important subject.
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