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Coimbra S, Rocha S, Sousa NR, Catarino C, Belo L, Bronze-da-Rocha E, Valente MJ, Santos-Silva A. Toxicity Mechanisms of Gadolinium and Gadolinium-Based Contrast Agents-A Review. Int J Mol Sci 2024; 25:4071. [PMID: 38612881 PMCID: PMC11012457 DOI: 10.3390/ijms25074071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have been used for more than 30 years to improve magnetic resonance imaging, a crucial tool for medical diagnosis and treatment monitoring across multiple clinical settings. Studies have shown that exposure to GBCAs is associated with gadolinium release and tissue deposition that may cause short- and long-term toxicity in several organs, including the kidney, the main excretion organ of most GBCAs. Considering the increasing prevalence of chronic kidney disease worldwide and that most of the complications following GBCA exposure are associated with renal dysfunction, the mechanisms underlying GBCA toxicity, especially renal toxicity, are particularly important. A better understanding of the gadolinium mechanisms of toxicity may contribute to clarify the safety and/or potential risks associated with the use of GBCAs. In this work, a review of the recent literature concerning gadolinium and GBCA mechanisms of toxicity was performed.
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Affiliation(s)
- Susana Coimbra
- 1H-TOXRUN—1H-Toxicology Research Unit, University Institute of Health Sciences, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Advanced Polytechnic and University Cooperative, CRL, 4585-116 Gandra, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Susana Rocha
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Nícia Reis Sousa
- Departamento de Ciências e Tecnologia da Saúde, Instituto Superior Politécnico de Benguela, Benguela, Angola
| | - Cristina Catarino
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Luís Belo
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Elsa Bronze-da-Rocha
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria João Valente
- National Food Institute, Technical University of Denmark, Kongens Lyngby, 2800 Copenhagen, Denmark
| | - Alice Santos-Silva
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
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Davies J, Siebenhandl-Wolff P, Tranquart F, Jones P, Evans P. Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration. Arch Toxicol 2022; 96:403-429. [PMID: 34997254 PMCID: PMC8837552 DOI: 10.1007/s00204-021-03189-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have transformed magnetic resonance imaging (MRI) by facilitating the use of contrast-enhanced MRI to allow vital clinical diagnosis in a plethora of disease that would otherwise remain undetected. Although over 500 million doses have been administered worldwide, scientific research has documented the retention of gadolinium in tissues, long after exposure, and the discovery of a GBCA-associated disease termed nephrogenic systemic fibrosis, found in patients with impaired renal function. An understanding of the pharmacokinetics in humans and animals alike are pivotal to the understanding of the distribution and excretion of gadolinium and GBCAs, and ultimately their potential retention. This has been well studied in humans and more so in animals, and recently there has been a particular focus on potential toxicities associated with multiple GBCA administration. The purpose of this review is to highlight what is currently known in the literature regarding the pharmacokinetics of gadolinium in humans and animals, and any toxicity associated with GBCA use.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK.
| | | | | | - Paul Jones
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
| | - Paul Evans
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
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Sousa NR, Rocha S, Santos-Silva A, Coimbra S, Valente MJ. Cellular and molecular pathways underlying the nephrotoxicity of gadolinium. Toxicol Sci 2021; 186:134-148. [PMID: 34878122 DOI: 10.1093/toxsci/kfab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mounting evidence on the short- and long-term adverse effects associated with gadolinium [Gd (III)]-based contrast agents used in magnetic resonance imaging have emerged in the past three decades. Safety issues arise from the release of Gd (III) from chelates and its deposition in tissues, which is exacerbated in patients with renal disease, since the kidney is the major excretion organ of most of these agents. This study aimed at unveiling the cellular and molecular mechanisms of nephrotoxicity of Gd (III), using an in vitro model of human proximal tubular cells (HK-2 cell line). Cell viability declined in a concentration- and time-dependent manner after exposure to GdCl3·6H2O. The estimated inhibitory concentrations (ICs) eliciting 1 to 50% of cell death, after 24 h of exposure, ranged from 3.4 to 340.5 µM. At toxic concentrations, exposure to Gd (III) led to disruption of the oxidative status, mitochondrial dysfunction, cell death by apoptosis, switching to necrosis at higher levels, and autophagic activation. Disturbance of the lipid metabolism was already observed at low-toxicity ICs, with accumulation of lipid droplets, and upregulation of genes related to both lipogenesis and lipolysis. Gd (III)-exposure, even at the subtoxic IC01, increased the expression of modulators of various signaling pathways involved in the development and progression of renal disease, including inflammation, hypoxia and fibrosis. Our results give new insights into the mechanisms underlying the nephrotoxic potential of Gd (III) and highlight the need to further clarify the risks versus benefits of the Gd (III)-based contrast agents currently in use.
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Affiliation(s)
- Nícia Reis Sousa
- TOXRUN-Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal.,Departamento de Ciências e Tecnologia da Saúde, Instituto Superior Politécnico de Benguela, Benguela, Angola
| | - Susana Rocha
- LAQV, REQUIMTE, Laboratório de Química Aplicada, Departamento de Ciências Químicas, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Alice Santos-Silva
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculdade de Farmácia da, Universidade do Porto, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Susana Coimbra
- TOXRUN-Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal.,Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculdade de Farmácia da, Universidade do Porto, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Maria João Valente
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculdade de Farmácia da, Universidade do Porto, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
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Martino F, Amici G, Rosner M, Ronco C, Novara G. Gadolinium-Based Contrast Media Nephrotoxicity in Kidney Impairment: The Physio-Pathological Conditions for the Perfect Murder. J Clin Med 2021; 10:jcm10020271. [PMID: 33450989 PMCID: PMC7828445 DOI: 10.3390/jcm10020271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for the possible development of systemic nephrogenic fibrosis and possible renal complications. This review focuses on the pathological mechanisms underlying the potential kidney toxicity of gadolinium. Gadolinium, as a free compound (Gd3+), is highly toxic in humans because it competes with divalent calcium (Ca2+) and magnesium (Mg2+) ions, interfering in some relevant biologic processes. Its toxicity is blunted by the complexing of Gd3+ with a carrier, allowing its use in magnetic resonance imaging. The binding reaction between gadolinium and a carrier is thermodynamically reversible. Consequently, under some conditions, gadolinium can be released in the interstitial space as a free Gd3+ compound with the possibility of toxicity. Other metals such as iron, copper, and calcium can interfere with the binding between gadolinium and its carrier because they compete for the same binding site. This process is known as transmetallation. In patients with kidney impairment, conditions such as low clearance of the Gd-carrier complex, acid-base derangements, and high serum phosphorous can increase the presence of free Gd3+, leading to a higher risk for toxicity.
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Affiliation(s)
- Francesca Martino
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy;
- UO Nephrology, Dialysis and Kidney Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- Correspondence: (F.M.); (G.N.); Tel.: +39-0444-753650 (F.M.); +39-049-8211250 (G.N.)
| | - Gianpaolo Amici
- UO Nephrology and Dialysis, San Daniele del Friuli and Tolmezzo Hospital, ASUFC, 33038 San Daniele del Friuli, Italy;
| | - Mitchell Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22903, USA;
| | - Claudio Ronco
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy;
- UO Nephrology, Dialysis and Kidney Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic University of Padua, 35124 Padova, Italy
- Correspondence: (F.M.); (G.N.); Tel.: +39-0444-753650 (F.M.); +39-049-8211250 (G.N.)
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Lattanzio SM. Toxicity associated with gadolinium-based contrast-enhanced examinations. AIMS BIOPHYSICS 2021. [DOI: 10.3934/biophy.2021015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Kader A, Brangsch J, Kaufmann JO, Zhao J, Mangarova DB, Moeckel J, Adams LC, Sack I, Taupitz M, Hamm B, Makowski MR. Molecular MR Imaging of Prostate Cancer. Biomedicines 2020; 9:1. [PMID: 33375045 PMCID: PMC7822017 DOI: 10.3390/biomedicines9010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 02/06/2023] Open
Abstract
This review summarizes recent developments regarding molecular imaging markers for magnetic resonance imaging (MRI) of prostate cancer (PCa). Currently, the clinical standard includes MR imaging using unspecific gadolinium-based contrast agents. Specific molecular probes for the diagnosis of PCa could improve the molecular characterization of the tumor in a non-invasive examination. Furthermore, molecular probes could enable targeted therapies to suppress tumor growth or reduce the tumor size.
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Affiliation(s)
- Avan Kader
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
- Department of Biology, Chemistry and Pharmacy, Institute of Biology, Freie Universität Berlin, Königin-Luise-Str. 1-3, 14195 Berlin, Germany
| | - Julia Brangsch
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
- Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Königsweg 67, Building 21, 14163 Berlin, Germany
| | - Jan O. Kaufmann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
- Division 1.5 Protein Analysis, Federal Institute for Materials Research and Testing (BAM), Richard-Willstätter-Str. 11, 12489 Berlin, Germany
- Department of Chemistry, Humboldt-Universität zu Berlin, Brook-Taylor-Str. 2, 12489 Berlin, Germany
| | - Jing Zhao
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
| | - Dilyana B. Mangarova
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
- Department of Veterinary Medicine, Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Str. 15, Building 12, 14163 Berlin, Germany
| | - Jana Moeckel
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
| | - Lisa C. Adams
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
| | - Ingolf Sack
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
| | - Matthias Taupitz
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
| | - Bernd Hamm
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
| | - Marcus R. Makowski
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (J.B.); (J.O.K.); (J.Z.); (D.B.M.); (J.M.); (L.C.A.); (I.S.); (M.T.); (B.H.); (M.R.M.)
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital Westminster Bridge Road, London SE1 7EH, UK
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich (TUM), Ismaninger Str. 22, 81675 München, Germany
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Malhotra N, Hsu HS, Liang ST, Roldan MJM, Lee JS, Ger TR, Hsiao CD. An Updated Review of Toxicity Effect of the Rare Earth Elements (REEs) on Aquatic Organisms. Animals (Basel) 2020; 10:E1663. [PMID: 32947815 PMCID: PMC7552131 DOI: 10.3390/ani10091663] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Rare earth elements (REEs) or "technology metals" were coined by the U.S. Department of Energy, a group of seventeen elements found in the Earth's crust. These chemical elements are vital and irreplaceable to the world of technology owing to their unique physical, chemical, and light-emitting properties, all of which are beneficial in modern healthcare, telecommunication, and defense. Rare earth elements are relatively abundant in Earth's crust, with critical qualities to the device performance. The reuse and recycling of rare earth elements through different technologies can minimize impacts on the environment; however, there is insufficient data about their biological, bioaccumulation, and health effects. The increasing usage of rare earth elements has raised concern about environmental toxicity, which may further cause harmful effects on human health. The study aims to review the toxicity analysis of these rare earth elements concerning aquatic biota, considering it to be the sensitive indicator of the environment. Based on the limited reports of REE effects, the review highlights the need for more detailed studies on the hormetic effects of REEs. Aquatic biota is a cheap, robust, and efficient platform to study REEs' toxicity, mobility of REEs, and biomagnification in water bodies. REEs' diverse effects on aquatic life forms have been observed due to the lack of safety limits and extensive use in the various sectors. In accordance with the available data, we have put in efforts to compile all the relevant research results in this paper related to the topic "toxicity effect of REEs on aquatic life".
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Affiliation(s)
- Nemi Malhotra
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung-Li 320314, Taiwan;
| | - Hua-Shu Hsu
- Department of Applied Physics, National Pingtung University, Pingtung 900391, Taiwan;
| | - Sung-Tzu Liang
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li 320314, Taiwan;
| | - Marri Jmelou M. Roldan
- Faculty of Pharmacy and The Graduate School, University of Santo Tomas, Manila 1008, Philippines;
| | - Jiann-Shing Lee
- Department of Applied Physics, National Pingtung University, Pingtung 900391, Taiwan;
| | - Tzong-Rong Ger
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung-Li 320314, Taiwan;
- Center for Nanotechnology, Chung Yuan Christian University, Chung-Li 320314, Taiwan
| | - Chung-Der Hsiao
- Department of Bioscience Technology, Chung Yuan Christian University, Chung-Li 320314, Taiwan;
- Center for Nanotechnology, Chung Yuan Christian University, Chung-Li 320314, Taiwan
- Department of Chemistry, Chung Yuan Christian University, Chung-Li 320314, Taiwan
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The gadolinium hypothesis for fibromyalgia and unexplained widespread chronic pain. Med Hypotheses 2019; 129:109240. [PMID: 31371082 DOI: 10.1016/j.mehy.2019.109240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/26/2019] [Accepted: 05/19/2019] [Indexed: 02/01/2023]
Abstract
Fibromyalgia (FM) is a chronic, painful, heterogeneous, and common disorder carrying a substantial socio-economical burden. It lacks effective cures and its aetiology is still unknown. There exists evidence for central and peripheral neurological contribution to the symptoms but grasping the real source of abnormal nervous system sensitization remains an ongoing challenge. There exists an association between an injury/trauma and the onset of the symptoms, but a causal relationship has not been yet sufficiently supported by scientific evidence. I postulate a role for gadolinium-based contrast agents and retention of gadolinium in the body. This conjecture breaks the hypothesis of a direct role for a physical injury/trauma per se in favour of an indirect one by the subsequent diagnostic procedures. It creates a new link between retention of gadolinium in the body and painful conditions as FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness. Experimental evidence demonstrates possible retention of gadolinium species in human body, still lacking conclusive answers on their pathological consequences. Notwithstanding, there exist some initial data that report unexplained chronic widespread pain and symptoms of FM in those patients: they are suggestive for pathological consequences associated with gadolinium retention. Besides clear compelling symptoms overlapping, biochemical findings are provided to sustain the hypothesis of a role for gadolinium in the disease process focusing on neurotransmitters, endogenous metal cations, cytokines, and muscle tissue. Experimental findings strongly support the hypothesis of impairment at the cellular, intracellular, and systemic levels in FM. And these data are highly compatible with collateral effects associated with the interference of the gadolinium ion and its pharmaceutical chelates into biochemical pathways in vivo. The hypothesis presented in this article, along with the support of scientific evidence, links FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness to retention of gadolinium in the body. If the hypothesis is confirmed, it could improve diagnosis and prevention, while providing a ground for development of new treatments.
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Nephrogenic Systemic Fibrosis: A Review of History, Pathophysiology, and Current Guidelines. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0312-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Rahatli FK, Donmez FY, Kibaroglu S, Kesim C, Haberal KM, Turnaoglu H, Agildere AM. Does renal function affect gadolinium deposition in the brain? Eur J Radiol 2018; 104:33-37. [PMID: 29857863 DOI: 10.1016/j.ejrad.2018.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/16/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Was to compare T1 signal intensity ratios of dentate nucleus to cerebellar white matter (DN/cerebellum), dentate nucleus to pons (DN/pons) and globus pallidus to thalamus (GP/thalamus) in patients with normal renal function and in patients on chronic hemodialysis. To find out if renal function affects the deposition of gadolinium in brain after administration of linear gadolinium based contrast agents (GBCA). METHODS Seventy eight contrast enhanced brain MRIs (Magnetic Resonance Imaging) with linear GBCA of 13 patients on chronic hemodialysis and 13 patients with normal renal function retrospectively evaluated. The DN/pons, DN/cerebellum and GP/thalamus signal intensity ratios were measured from each brain MRI on unenhanced axial T1 weighted images. RESULTS In hemodialysis group statistically significant increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus were found between the first and the last brain MRIs (p = .001). The increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus between the first and the last brain MRIs in control group were not significant (p > 0.05). The signal intensity increase in DN and globus pallidus were significantly higher in hemodialysis group than control group (p < 0.05). CONCLUSIONS Patients on hemodialysis had significantly higher DN and GP signal intensity increase compared to the patients with normal renal function. Renal function affects the rate of gadolinium deposition in the brain after administration of linear GBCA.
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Affiliation(s)
- Feride Kural Rahatli
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | | | - Seda Kibaroglu
- Baskent University, Faculty of Medicine, Department of Neurology, Ankara, Turkey.
| | - Cagri Kesim
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Kemal Murat Haberal
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Hale Turnaoglu
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
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Abstract
Recently, there have been numerous major peer-reviewed publications reporting deposition of gadolinium in the dentate nucleus and globus pallidus in subjects with normal renal function. This review takes a retrospective look back through the development of gadolinium-based contrast agents to describe the historical evidence of gadolinium deposition in vivo and shows that deposition in the basal ganglia should come as no surprise. Evidence for gadolinium deposition in both animal models and human patients is described. Stability differences among gadolinium contrast agents have long been recognized in vitro, and deposition of gadolinium in tissues has been described in animal models since at least 1984. The first major study that showed deposition in humans appeared in 1998 regarding patients with renal failure and in 2004 in patients with normal renal function. The historical literature indicates that gadolinium retention in healthy patients is occurring, although the clinical consequences of deposition remain unknown.
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Prybylski JP, Maxwell E, Coste Sanchez C, Jay M. Gadolinium deposition in the brain: Lessons learned from other metals known to cross the blood-brain barrier. Magn Reson Imaging 2016; 34:1366-1372. [PMID: 27580521 DOI: 10.1016/j.mri.2016.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/20/2016] [Indexed: 01/18/2023]
Abstract
The recent discovery of gadolinium (Gd) deposition in the brains of patients receiving Gd-based contrast agents (GBCAs) raises several important questions including by what mechanism Gd or GBCAs pass through the blood-brain barrier. Decades of research focused on the safety and stability of GBCAs have not identified any mechanism of uptake. Here we review findings of Gd deposition from human and animal data, and how distribution mechanisms elucidated for endogenous and toxic metals may explain entrance of Gd into the central nervous system. Three general uptake mechanisms are considered along with examples of metals known to enter the central nervous system by these routes: (1) carrier-mediated, (2) transporter-mediated and (3) passive. The potential for chelation therapy to reduce deposition is also discussed. The work reported for other metals provides guidance for how the mechanism of Gd deposition in the brain can be determined which is essential information for rational prevention or treatment.
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Affiliation(s)
- John P Prybylski
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
| | - Erin Maxwell
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
| | - Carla Coste Sanchez
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
| | - Michael Jay
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
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Feng M, Fan YZ, Ma XJ, Li JX, Yang XG. The gadolinium-based contrast agent Omniscan® promotes in vitro fibroblast survival through in situ precipitation. Metallomics 2016; 7:1103-10. [PMID: 25867453 DOI: 10.1039/c5mt00055f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The current study aims to explore how the gadolinium (Gd)-based contrast agent (GBCA) Omniscan® enhanced cell viability of murine fibroblasts. The results of scanning electron microscopy showed that Omniscan® can precipitate in cell culture media and deposit on cell membranes. Energy-dispersive X-ray analysis and Fourier-transform infrared spectroscopy demonstrated the presence of Gd and phosphates in the agglomerated particles. By filtering the Omniscan®-containing medium through a 220 nm filter, it can be clearly found that the increased cell viability should be mainly attributed to the insoluble species of gadolinium rather than to chelated gadolinium. Moreover, the effects of other gadolinium-based contrast agents, Magnevist® and Dotarem®, were compared with that of Omniscan®. It is noted that the three contrast agents differed in their ability to induce cell viability, which is possibly ascribed to the different chemical stabilities of gadolinium chelates as demonstrated by the attenuation in cell growth upon the addition of excess ligands to the compounds. The results of flow cytometry analysis also showed that Omniscan® can promote cell growth via an increase in the S-phase cell population as evidenced by the elevated levels of cell cycle associated proteins cyclin D, cyclin A and the phosphorylated Rb protein. Furthermore, our results revealed that integrin-mediated signaling may play an important role in both Omniscan® and Magnevist®-enhanced focal adhesion formation since the blockade of integrins decreased the level of ERK phosphorylation induced by the two GBCAs. Taken together, these data suggested that in situ gadolinium phosphate precipitation formation mediated Omniscan®-promoted fibroblast survival, which is similar to that of gadolinium chloride. It was demonstrated that the application of GBCAs with more stable thermodynamic stability may cause less dissociation of the gadolinium ion and thus resulted in less precipitation, finally leading to lower occurrence of nephrogenic systemic fibrosis. The obtained results would also be helpful for the development of safe gadolinium-based contrast agents.
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Affiliation(s)
- Min Feng
- Department of Chemical Biology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, People's Republic of China.
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Qiu L, Tang Y, Chen Y, Huang Z, Zhu Y, Zhang L, Cai L, Wan Q, Feng Y. The effect of MRI contrast agents on hepatic and splenic uptake in the rabbit during (99m) Tc-MDP bone scintigraphy. CONTRAST MEDIA & MOLECULAR IMAGING 2015; 10:438-45. [PMID: 26036779 DOI: 10.1002/cmmi.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/26/2015] [Accepted: 04/09/2015] [Indexed: 11/09/2022]
Abstract
The objective of this study was to investigate the effects of Omniscan® and Magnevist® on (99m) Tc-MDP uptake in rabbits during (99m) Tc-MDP bone scintigraphy. In Experiment Group 1, 30 healthy adult rabbits were randomized into six subgroups (n = 5); each subgroup experienced a different time interval between injections (30 min, 60 min, 120 min, 240 min, 360 min, 24 h). All six subgroups were injected first with Omniscan®, then with (99m) Tc-MDP. After 7 days, the same six subgroups were injected with normal saline followed by (99m) Tc-MDP at the same time intervals. In Experiment Group 2, 20 healthy adult rabbits were allocated randomly to four subgroups (n = 5); each subgroup experienced a different time interval between injections (30 min, 60 min, 120 min, 240 min). All four subgroups were injected first with Magnevist®, then with (99m) Tc-MDP. After 7 days, the same four subgroups were injected with normal saline followed by (99m) Tc-MDP. In all experiments, whole-body skeletal imaging was performed. Liver, spleen, and background were delineated to determine the target-to-background (T/B) ratio. Diffusely increased intake of the imaging agent was seen in the liver and spleen when the injection-time interval between Omniscan® and (99m) Tc-MDP varied from 30 min to 240 min and when the time interval between Magnevist® and (99m) Tc-MDP was 30 min-60 min. The imaging findings are consistent with the results of L/B and S/B ratios in each experiment group. Both Omniscan® and Magnevist® have an effect on (99m) Tc-MDP uptake during bone scanning; the main effect is diffusely increased hepatic and splenic activity.
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Affiliation(s)
- Lin Qiu
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yuhui Tang
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yue Chen
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Zhanwen Huang
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yan Zhu
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Li Zhang
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Liang Cai
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Qiang Wan
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yue Feng
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
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Schmidt-Lauber C, Bossaller L, Abujudeh HH, Vladimer GI, Christ A, Fitzgerald KA, Latz E, Gravallese EM, Marshak-Rothstein A, Kay J. Gadolinium-based compounds induce NLRP3-dependent IL-1β production and peritoneal inflammation. Ann Rheum Dis 2014; 74:2062-9. [PMID: 24914072 DOI: 10.1136/annrheumdis-2013-204900] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 05/22/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Nephrogenic systemic fibrosis (NSF) is a progressive fibrosing disorder that may develop in patients with chronic kidney disease after administration of gadolinium (Gd)-based contrast agents (GBCAs). In the setting of impaired renal clearance of GBCAs, Gd deposits in various tissues and fibrosis subsequently develops. However, the precise mechanism by which fibrosis occurs in NSF is incompletely understood. Because other profibrotic agents, such as silica or asbestos, activate the nucleotide-binding oligomerisation domain (NOD)-like receptor protein 3 (NLRP3) inflammasome and initiate interleukin (IL)-1β release with the subsequent development of fibrosis, we evaluated the effects of GBCAs on inflammasome activation. METHODS Bone marrow derived macrophages from C57BL/6, Nlrp3(-/-) and Asc(-/-) mice were incubated with three Gd-containing compounds and IL-1β activation and secretion was detected by ELISA and western blot analysis. Inflammasome activation and regulation was investigated in IL-4- and interferon (IFN)γ-polarised macrophages by ELISA, quantitative real time (qRT)-PCR and NanoString nCounter analysis. Furthermore, C57BL/6 and Nlrp3(-/-)mice were intraperitoneally injected with GBCA and recruitment of inflammatory cells to the peritoneum was analysed by fluorescence-activated cell sorting (FACS). RESULTS Free Gd and GBCAs activate the NLRP3 inflammasome and induce IL-1β secretion in vitro. Gd-diethylenetriaminepentaacetic acid also induces the recruitment of neutrophils and inflammatory monocytes to the peritoneum in vivo. Gd activated IL-4-polarised macrophages more effectively than IFNγ-polarised macrophages, which preferentially expressed genes known to downregulate inflammasome activity. CONCLUSIONS These data suggest that Gd released from GBCAs triggers a NLRP3 inflammasome-dependent inflammatory response that leads to fibrosis in an appropriate clinical setting. The preferential activation of IL-4-differentiated macrophages is consistent with the predominantly fibrotic presentation of NSF.
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Affiliation(s)
- Christian Schmidt-Lauber
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lukas Bossaller
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Hani H Abujudeh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory I Vladimer
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anette Christ
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Katherine A Fitzgerald
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Eicke Latz
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA Institute of Innate Immunity, University of Bonn and German Center of Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Ellen M Gravallese
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ann Marshak-Rothstein
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Current status of nephrogenic systemic fibrosis. Clin Radiol 2014; 69:661-8. [PMID: 24582176 DOI: 10.1016/j.crad.2014.01.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/24/2013] [Accepted: 01/06/2014] [Indexed: 12/14/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) occurs in patients with advanced chronic kidney disease (CKD) or acute renal failure, most commonly following exposure to gadolinium-based contrast agents (GBCAs). NSF can be debilitating and associated with increased mortality. The putative association of NSF with GBCAs prompted the development of guidelines to limit the use of these contrast agents in at-risk patients. Indeed, the incidence of NSF has decreased dramatically following application of these guidelines, which appears to be the only effective means of decreasing NSF incidence. Thus, increasing clinician awareness of these updated guidelines is important. The present review introduces and compares updated guidelines for GBCA use and discusses the latest advances in the understanding of the pathogenic mechanisms and treatment of NSF.
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Wermuth PJ, Jimenez SA. Induction of a type I interferon signature in normal human monocytes by gadolinium-based contrast agents: comparison of linear and macrocyclic agents. Clin Exp Immunol 2014; 175:113-25. [PMID: 24111526 DOI: 10.1111/cei.12211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 12/18/2022] Open
Abstract
The gadolinium-based contrast agent (GdBCA) Omniscan activates human macrophages through Toll-like receptor (TLR)-4 and TLR-7 signalling. To explore the mechanisms responsible we compared the ability of linear and macrocyclic GdBCA to induce a type I interferon signature and a proinflammatory/profibrotic phenotype in normal human monocytes in vitro. Expression of genes associated with type I interferon signalling and inflammation and production of their corresponding proteins were determined. Both linear and macrocyclic GdBCA stimulated expression of multiple type I interferon-regulated genes and the expression of numerous chemokines, cytokines and growth factors in normal human peripheral blood monocytes. There was no correlation between the magnitude of the measured response and the Gd chelate used. To explore the mechanisms responsible for GdBCA induction of fibrosis in nephrogenic systemic fibrosis (NSF) in vitro, normal human dermal fibroblasts were incubated with GdBCA-treated monocyte culture supernatants and the effects on profibrotic gene expression were examined. Supernatants from monocytes exposed to all GdBCA stimulated types I and III collagen, fibronectin and α-smooth muscle actin (α-SMA) expression in normal dermal fibroblasts. The results indicate that the monocyte activation induced by GdBCA may be the initial step in the development of GdBCA associated fibrosis in NSF.
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Affiliation(s)
- P J Wermuth
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Nephrogenic systemic fibrosis in Denmark--a nationwide investigation. PLoS One 2013; 8:e82037. [PMID: 24349178 PMCID: PMC3857209 DOI: 10.1371/journal.pone.0082037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/20/2013] [Indexed: 12/17/2022] Open
Abstract
Background Nephrogenic systemic fibrosis is a debilitating and painful disorder with an increased stimulation of the connective tissue in the skin and systemic tissues. The disease is associated with exposure to gadolinium-based contrast agent used in magnetic resonance imaging in patients with renal impairment. Methods The prevalence of nephrogenic systemic fibrosis has so far never been determined at a national level. In 2009, Denmark was the first country to design a guideline for the tracing of nephrogenic systemic fibrosis patients. The aim of this paper is to communicate the main findings of this quest. Results The outcome of the nationwide investigation revealed that Denmark had 65 patients with nephrogenic systemic fibrosis and thereby the highest prevalence of nephrogenic systemic fibrosis worldwide with 65 per 5.6 million inhabitants, or 12 per million. Conclusions The nationwide investigation in Denmark revealed the highest prevalence of NSF worldwide. This may be rooted in a high level of awareness of NSF both among doctors, politicians and, not least, the media, combined with the fact that a nationwide NSF investigation was initiated.
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Is "appearing chronically ill" a sign of poor health? A study of diagnostic accuracy. PLoS One 2013; 8:e79934. [PMID: 24312192 PMCID: PMC3842283 DOI: 10.1371/journal.pone.0079934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 10/01/2013] [Indexed: 11/19/2022] Open
Abstract
Objective To determine the sensitivity and specificity of a physician’s assessment that a patient “appears chronically ill” for the detection of poor health status. Methods The health status of 126 adult outpatients was determined using the 12-Item Short Form Health Survey (SF-12). Physician participants (n = 111 residents and faculty) viewed photographs of each patient participant and assessed whether or not the patient appeared chronically ill. For the entire group of physicians, the median sensitivity and specificity of “appearing chronically ill” for the detection of poor health status (defined as SF-12 physical health score below age group norms by at least 1 SD) were calculated. The study took place from February 2009 to January 2011. Results Forty-two participants (33%) had an SF-12 physical health score ≥1 SD below age group norms, and 22 (18%) had a score ≥2 SD below age group norms. When poor health status was defined as an SF-12 physical score ≥1 SD below age group norms, the median sensitivity was 38.1% (IQR 28.6–47.6%), specificity 78.6% (IQR 69.0–84.0%), positive likelihood ratio 1.64 (IQR 1.42–2.15), and negative likelihood ratio 0.82 (IQR 0.74–0.87). For an SF-12 physical score ≥2 SD below age group norms, the median sensitivity was 45.5% (IQR 36.4–54.5%), specificity 76.9% (IQR 66.3–83.7%), positive likelihood ratio 1.77 (IQR 1.49–2.25), and negative likelihood ratio 0.75 (IQR 0.66–0.86). Conclusions Our study suggests that a physician’s assessment that a patient “appears chronically ill” has poor sensitivity and modest specificity for the detection of poor health status in adult outpatients. The associated likelihood ratios indicate that this assessment may have limited diagnostic value.
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Lima XT, Alora-Palli MB, Kimball AB, Kay J. Validation of a Screening Instrument for Nephrogenic Systemic Fibrosis. Arthritis Care Res (Hoboken) 2013; 65:637-42. [DOI: 10.1002/acr.21877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 10/03/2012] [Indexed: 11/08/2022]
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Wagner B, Tan C, Barnes JL, Ahuja S, Davis TL, Gorin Y, Jimenez F. Nephrogenic systemic fibrosis: evidence for oxidative stress and bone marrow-derived fibrocytes in skin, liver, and heart lesions using a 5/6 nephrectomy rodent model. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:1941-52. [PMID: 23041060 DOI: 10.1016/j.ajpath.2012.08.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 08/09/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) is associated with gadolinium-based magnetic resonance imaging (MRI) contrast exposure in the setting of acute or chronic renal compromise. It has been proposed that circulating fibrocytes mediate the disease. A study was conducted to determine whether bone marrow-derived fibroblast precursors are involved in contributing to organ fibrosis in MRI contrast-treated rodents with renal insufficiency. Rats status post 5/6 nephrectomy underwent bone marrow transplant from human placental alkaline phosphatase (hPAP)-expressing donors. After engraftment, animals were treated with gadolinium-based MRI contrast (2.5 mmol/kg IP), during weekdays for 4 weeks, or an equivalent volume of normal saline. Dermal cellularity in the contrast-treated group was fourfold that of control. Skin cells from the contrast-treated group demonstrated greater hPAP expression with co-expression of pro-collagen I and α-smooth muscle actin-positive stress fibers. Donor and host cells expressed CD34. Dihydroethidium staining of skin was greater in the contrast-treated animals, indicating oxidative stress. This was abrogated when the animals were co-administered the superoxide dismutase mimetic tempol. In conclusion, a bone marrow-derived cell population is increased in the dermis of MRI contrast-treated rodents. The cell markers are consistent with fibrocytes mediating the disease. These changes correlate with oxidative stress and expression of Nox4, suggestive of a novel therapeutic target. Elucidation of the mechanisms of MRI contrast-induced fibrosis may aid in discovering therapies to this devastating disease.
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Affiliation(s)
- Brent Wagner
- VA Research, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, TX 78229, USA.
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Abstract
OBJECTIVE The purpose of this article is to discuss nephrogenic systemic fibrosis (NSF) in detail regarding its history, possible pathophysiology, clinical and pathologic presentations, diagnosis, and implications for the radiology community. CONCLUSION NSF is a potentially lethal disorder that occurs in patients with reduced kidney function. Current evidence suggests a strong association with gadolinium-based contrast agents--mostly used in MRI--in this patient group. This has urged the radiology community to emphasize careful screening for the presence of renal dysfunction among patients for whom gadolinium-enhanced MRI is contemplated. Appropriate selection of gadolinium-based contrast agent type, avoidance of nonstandard dosage, patient education, and informed consent have been recommended by authorities.
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Bernstein EJ, Schmidt-Lauber C, Kay J. Nephrogenic systemic fibrosis: A systemic fibrosing disease resulting from gadolinium exposure. Best Pract Res Clin Rheumatol 2012; 26:489-503. [DOI: 10.1016/j.berh.2012.07.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/17/2012] [Indexed: 12/18/2022]
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Schopf E, Sankaranarayanan J, Chan M, Mattrey R, Almutairi A. An extracellular MRI polymeric contrast agent that degrades at physiological pH. Mol Pharm 2012; 9:1911-8. [PMID: 22657107 PMCID: PMC3443308 DOI: 10.1021/mp2005998] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Macromolecular contrast agents have the potential to assist magnetic resonance imaging (MRI) due to their high relaxivity, but are not clinically useful because of toxicity due to poor clearance. We have prepared a biodegradable ketal-based polymer contrast agent which is designed to degrade rapidly at physiological pH by hydrolysis, facilitating renal clearance. In vitro, the agent degraded more rapidly at lower pH, with complete fragmentation after 24 h at pH 7.4. In vitro relaxivity measurements showed a direct correlation between molecular weight and relaxivity. We compared our polymer contrast agent with commercially available Magnevist in vivo by MRI imaging, as well as measuring the Gd concentration in blood. Our results show that our polymer contrast agent gives a higher contrast and intensity in the same organs and areas as Magnevist and is cleared from the blood at a similar rate. We aim to improve our polymer contrast agent design to develop it for use as a MRI contrast agent, and explore its use as a platform for other imaging modalities.
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Affiliation(s)
- Eric Schopf
- Skaggs School of Pharmacy and Pharmaceutical Sciences, ⊥Department of NanoEngineering, §Department of Chemistry, and ∥Department of Radiology, University of California at San Diego , La Jolla, California 92093, United States
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RITCHIE JAMES, CHRYSOCHOU CONSTANTINA, KALRA PHILIPA. Contemporary management of atherosclerotic renovascular disease: Before and after ASTRAL. Nephrology (Carlton) 2011; 16:457-67. [DOI: 10.1111/j.1440-1797.2011.01474.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abu-Alfa AK. Nephrogenic systemic fibrosis and gadolinium-based contrast agents. Adv Chronic Kidney Dis 2011; 18:188-98. [PMID: 21531325 DOI: 10.1053/j.ackd.2011.03.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 12/26/2022]
Abstract
The strong association between nephrogenic systemic fibrosis (NSF) and exposure to gadolinium-based contrast agents (GBCAs) has greatly affected the care of patients with kidney disease. NSF has been reported in patients with ESRD, CKD, and acute kidney injury (AKI). The majority of cases have occurred in patients with ESRD, but about 20% have been reported in patients with AKI or CKD stages 4 and 5. There is also a risk difference among GBCAs, with the Food and Drug Administration contraindicating 3 linear agents in patients at risk. Given the significant morbidity and mortality of NSF, it is imperative to identify individuals at risk. Although there are no data to support a role for hemodialysis (HD) in reducing the risk for NSF after administration of GBCAs, immediate HD is still recommended within 2 hours. Patients maintained on peritoneal dialysis seem to be at high risk and immediate HD is also recommended. However, this is not the current recommendation for CKD stages 4 and 5, especially with suspected lower risk of noncontraindicated agents. Individualized assessment is important and especially in those patients close to dialysis initiation. Instituting policies is important to address the imaging needs of patients with CKD and AKI while ensuring a balance between benefits and risks.
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Quantitative assessment of dermal cellularity in nephrogenic systemic fibrosis: A diagnostic aid. J Am Acad Dermatol 2011; 64:741-7. [DOI: 10.1016/j.jaad.2010.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/13/2010] [Accepted: 05/26/2010] [Indexed: 12/31/2022]
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Sanyal S, Marckmann P, Scherer S, Abraham JL. Multiorgan gadolinium (Gd) deposition and fibrosis in a patient with nephrogenic systemic fibrosis--an autopsy-based review. Nephrol Dial Transplant 2011; 26:3616-26. [DOI: 10.1093/ndt/gfr085] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2011; 64:91-6. [DOI: 10.1016/j.jaad.2009.12.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 12/11/2009] [Accepted: 12/21/2009] [Indexed: 11/22/2022]
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Aime S, Caravan P. Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging 2010; 30:1259-67. [PMID: 19938038 DOI: 10.1002/jmri.21969] [Citation(s) in RCA: 387] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The biodistribution of approved gadolinium (Gd)-based contrast agents (GBCAs) is reviewed. After intravenous injection GBCAs distribute in the blood and the extracellular space and transiently through the excretory organs. Preclinical animal studies and the available clinical literature indicate that all these compounds are excreted intact. Elimination tends to be rapid and, for the most part, complete. In renally insufficient patients the plasma elimination half-life increases substantially from hours to days depending on renal function. In patients with impaired renal function and nephrogenic systemic fibrosis (NSF), the agents gadodiamide, gadoversetamide, and gadopentetate dimeglumine have been shown to result in Gd deposition in the skin and internal organs. In these cases, it is likely that the Gd is no longer present as the GBCA, but this has still not been definitively shown. In preclinical models very small amounts of Gd are retained in the bone and liver, and the amount retained correlates with the kinetic and thermodynamic stability of the GBCA with respect to Gd release in vitro. The pattern of residual Gd deposition in NSF subjects may be different than that observed in preclinical rodent models. GBCAs are designed to be used via intravenous administration. Altering the route of administration and/or the formulation of the GBCA can dramatically alter the biodistribution of the GBCA and can increase the likelihood of Gd deposition. J. Magn. Reson. Imaging 2009;30:1259-1267. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Silvio Aime
- Department of Chemistry IFM and Molecular Imaging Center, University of Torino, Torino, Italy
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Li JX, Liu JC, Wang K, Yang XG. Gadolinium-containing bioparticles as an active entity to promote cell cycle progression in mouse embryo fibroblast NIH3T3 cells. J Biol Inorg Chem 2010; 15:547-57. [DOI: 10.1007/s00775-010-0622-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 12/16/2009] [Indexed: 01/08/2023]
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Koreishi AF, Nazarian RM, Saenz AJ, Klepeis VE, McDonald AG, Farris AB, Colvin RB, Duncan LM, Mandal RV, Kay J. Nephrogenic systemic fibrosis: a pathologic study of autopsy cases. Arch Pathol Lab Med 2010; 133:1943-8. [PMID: 19961249 DOI: 10.5858/133.12.1943] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT -Nephrogenic systemic fibrosis (NSF) is a rare but serious disorder initially described as a purely dermatologic process. Isolated autopsy reports have described multiorgan involvement by this disease. OBJECTIVE -To further illustrate the varied and systemic involvement of NSF by describing the autopsy experience at the Massachusetts General Hospital. DESIGN -We describe the findings in a series of 4 autopsy cases of patients diagnosed with NSF. This report describes the history of renal dysfunction, exposure to gadolinium-containing contrast agents, specific laboratory parameters, and the extent of systemic involvement identified by postmortem examination. RESULTS -Causes of death included systemic thromboembolic disease (n = 3) and pneumonia (n = 1). Laboratory parameters and type, dose, or timing of gadolinium-containing contrast-agent exposure did not correlate with clinical findings and outcomes. All patients demonstrated cutaneous manifestations of the disease and nephrocalcinosis, with some exhibiting calcification and fibrosis of the dura, thyroid, and heart including the cardiac conduction system, on postmortem examination. Soft tissue calcification was associated with concurrent hyperparathyroidism or high serum parathyroid hormone levels. CONCLUSIONS -Thromboembolic disease can be a significant clinical complication of NSF. Patients with NSF may also develop characteristic histologic features of fibrosis and calcification in multiple organs, with significant morbidity and mortality. This autopsy series highlights the variability of systemic manifestations of NSF.
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Affiliation(s)
- Aashiyana F Koreishi
- Department of Pathology, James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Goffin E, Schroeder JA, Weingart C, Decleire PY, Cosyns JP. Absence of gadolinium deposits in the peritoneal membrane of patients with encapsulating peritoneal sclerosis. Nephrol Dial Transplant 2009; 25:1334-9. [DOI: 10.1093/ndt/gfp664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abujudeh HH, Rolls H, Kaewlai R, Agarwal S, Gebreananya ZA, Saini S, Schaefer PW, Kay J. Retrospective assessment of prevalence of nephrogenic systemic fibrosis (NSF) after implementation of a new guideline for the use of gadobenate dimeglumine as a sole contrast agent for magnetic resonance examination in renally impaired patients. J Magn Reson Imaging 2009; 30:1335-40. [DOI: 10.1002/jmri.21976] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Kroshinsky D, Kay J, Nazarian RM. Case records of the Massachusetts General Hospital. Case 37-2009. A 46-year-old woman with chronic renal failure, leg swelling, and skin changes. N Engl J Med 2009; 361:2166-76. [PMID: 19940302 DOI: 10.1056/nejmcpc0907802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Caravan P, Kay J, Mandal RV, Uppal R, Welby J, Deb A, Penner-Hahn JE. CMR2009: 5.04: Post-mortem analysis of gadolinium distribution in NSF subjects. CONTRAST MEDIA & MOLECULAR IMAGING 2009. [DOI: 10.1002/cmmi.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abujudeh HH, Kaewlai R, Kagan A, Chibnik LB, Nazarian RM, High WA, Kay J. Nephrogenic Systemic Fibrosis after Gadopentetate Dimeglumine Exposure: Case Series of 36 Patients. Radiology 2009; 253:81-9. [DOI: 10.1148/radiol.2531082160] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Wermuth PJ, Del Galdo F, Jiménez SA. Induction of the expression of profibrotic cytokines and growth factors in normal human peripheral blood monocytes by gadolinium contrast agents. ACTA ACUST UNITED AC 2009; 60:1508-18. [PMID: 19404939 DOI: 10.1002/art.24471] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Nephrogenic systemic fibrosis (NSF) is a severe fibrosing disorder occurring in patients with renal insufficiency. The majority of patients with this disorder have documented exposure to magnetic resonance imaging contrast agents containing Gd. The purpose of this study was to examine the effects of gadolinium diethylenetriaminepentaacetic acid bismethylamide (Gd[DTPA-BMA]; Omniscan) as compared with Gd-DTPA and GdCl3 on the expression and production of cytokines and growth factors by normal human peripheral blood monocytes in vitro and to examine whether conditioned media from Gd-exposed peripheral blood monocytes could induce a profibrotic phenotype in dermal fibroblasts. METHODS Normal human peripheral blood monocytes isolated by Ficoll-Hypaque gradient centrifugation and plastic adherence were incubated with various concentrations of Gd[DTPA-BMA], Gd-DTPA, or GdCl3. Gene expression of interleukins 4, 6, and 13, interferon-gamma, tumor necrosis factor alpha, transforming growth factor beta, connective tissue growth factor, and vascular endothelial growth factor were assessed by real-time polymerase chain reaction (PCR) analysis. Production and secretion of cytokines and growth factors by Gd compound-exposed monocytes was quantified by enzyme-linked immunosorbent assay proteome multiplex arrays. The effects of conditioned media from the Gd compound-exposed monocytes on the phenotype of normal human dermal fibroblasts were examined by real-time PCR and Western blotting. RESULTS The 3 Gd-containing compounds stimulated the expression and production of numerous cytokines and growth factors by normal human peripheral blood monocytes. Conditioned media from these cells induced a profibrotic phenotype in normal human dermal fibroblasts. CONCLUSION The 3 Gd-containing compounds studied induce potent cellular responses in normal human peripheral blood monocytes, which may participate in the development of tissue fibrosis in NSF.
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Affiliation(s)
- Peter J Wermuth
- Thomas Jefferson University, Jefferson Institute of Molecular Medicine, Philadelphia, Pennsylvania 19107, USA
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heher EC, Thier SO, Rennke H, Humphreys BD. Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation. Clin J Am Soc Nephrol 2008; 3:1494-503. [PMID: 18596115 DOI: 10.2215/cjn.02040408] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Colorectal cancer can be prevented by the removal of adenomatous polyps during screening colonoscopy, but adequate bowel preparation is required. Oral sodium phosphate (OSP), an effective bowel purgative, is available over the counter and requires a substantially lower volume than polyethylene glycol-based preparative agents. Accumulating reports implicate OSP in electrolyte disturbances as well as acute kidney injury (AKI) in a syndrome termed phosphate nephropathy (a form of nephrocalcinosis). Despite published case reports and case series, the actual incidence, risk factors, and natural history of phosphate nephropathy remain largely undefined. Several recent observational studies have provided new information on these important issues while supporting a link between OSP and acute phosphate nephropathy as well as the development of chronic kidney disease in elderly patients, many of whom had a normal serum creatinine at the time of OSP ingestion. This review summarizes current knowledge about the renal complications of OSP, risk factors for its development, and the pathophysiology of acute and chronic kidney damage in nephrocalcinosis.
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Affiliation(s)
- Eliot C Heher
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Khurana A, Greene JF, High WA. Quantification of gadolinium in nephrogenic systemic fibrosis: re-examination of a reported cohort with analysis of clinical factors. J Am Acad Dermatol 2008; 59:218-24. [PMID: 18538448 DOI: 10.1016/j.jaad.2008.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/07/2008] [Accepted: 04/12/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nephrogenic systemic fibrosis (NSF) has been associated with exposure to gadolinium-based contrast agent (GdCA) used in medical imaging. OBJECTIVE We sought to quantify levels of gadolinium in affected skin of patients with NSF and correlate the levels to clinical and laboratory parameters. METHODS Skin biopsy specimens were analyzed using inductively coupled plasma mass spectroscopy (ICP-MS) and the micrograms of gadolinium per gram (microg/g) of dry tissue were determined. Clinical and laboratory data were obtained through retrospective chart review. Pearson correlation coefficients were used to correlate tissue gadolinium levels with various parameters. RESULTS Six patients from a prior cohort were analyzed for gadolinium in affected skin. The mean amount of gadolinium in affected skin of NSF patients was 320.1 microg/g. No gadolinium was found in limited control tissue from patients unexposed to GdCA or in patients exposed to such agents, but without disease. Higher levels of gadolinium in skin correlated with younger age, lower body weight, lower corrected serum calcium levels, and lower erythropoietin dosing. LIMITATIONS The study was limited by the small number of cases and by the retrospective nature of the data and skin samples. CONCLUSION Gadolinium is present in substantial amounts within the skin of patients with NSF. Quantification of gadolinium in tissue using ICP-MS may facilitate our understanding of the disease.
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Affiliation(s)
- Anand Khurana
- Department of Nephrology, Scott & White Clinic, Texas A & M University, College Station, Texas, USA
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