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Arriaga Escamilla D, Lakhani A, Antony S, Salazar Villegas KN, Gupta M, Ramnath P, Murillo Pineda MI, Bedor A, Banegas D, Calderon Martinez E. Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review. Cureus 2024; 16:e52253. [PMID: 38352109 PMCID: PMC10863542 DOI: 10.7759/cureus.52253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive disease and has multiple clinical manifestations; when CKD reaches the end stage, at least one cutaneous manifestation appears due to some increased toxin levels or a constant proinflammatory state. Nonspecific manifestations include pruritus, xerosis, pigmentation disorders, acquired ichthyosis, purpuric spots, and nail disorders. Some specific manifestations are bullous dermatoses, acquired perforating dermatoses (APD), eruptive xanthoma, access site infections, calcifying disorders, and nephrogenic systemic fibrosis (NSF). All these cutaneous changes negatively impact patients; early recognition and diagnosis of these dermatoses will make a difference in their quality of treatment. Exploring a patient's skin is fundamental to suspect some diseases and increased toxin levels; pruritus occurs when uremic toxins are raised, and nail disorders are associated with hypoalbuminemia. This review provides the clinician with information on the clinical manifestations that occur in CKD, including epidemiology, pathophysiology, clinical manifestations, diagnosis, histopathology, treatment, and life impact of the dermatoses in CKD.
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Affiliation(s)
| | - Alisha Lakhani
- Medicine, Research MD, Vadodara, IND
- Medicine, Shantabaa Medical College, Amreli, IND
| | - Sneha Antony
- Pharmacology, K S Hegde Medical Academy, Mangalore, IND
| | | | - Manasvi Gupta
- General Practice, Jawaharlal Nehru Medical College, Aligarh, IND
| | | | | | - Alexandra Bedor
- Internal Medicine, Instituto Salvadoreño del Seguro Social, San Salvador, SLV
| | - Douglas Banegas
- General Medicine, Universidad Nacional Autonoma de Honduras, San Pedro Sula, HND
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Li Y, Zeng Y, Chen Z, Nie S, Wu Z. Nodular and diffuse spindle cell infiltration in keloidal scleroderma: a case report. Front Med (Lausanne) 2023; 10:1291941. [PMID: 38164220 PMCID: PMC10758199 DOI: 10.3389/fmed.2023.1291941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Keloidal scleroderma is a variant of scleroderma that presents as firm keloidal nodules or plaques. Due to the similarity in morphology and pathology, it is often distinguished from a hypertrophic scar or keloid. We report a case of keloidal scleroderma with rare nodular and diffuse spindle cell infiltration in histopathology. Recognition of this unusual histopathological feature may help clinicians improve their knowledge and avoid misdiagnosis.
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Affiliation(s)
- Yiting Li
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yibin Zeng
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, China
| | - Zile Chen
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu Nie
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhouwei Wu
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Starekova J, Pirasteh A, Reeder SB. Update on Gadolinium Based Contrast Agent Safety, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol 2023. [PMID: 37850581 DOI: 10.2214/ajr.23.30036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Since its introduction 35 years ago, gadolinium-enhanced MRI has fundamentally changed medical practice. While extraordinarily safe, gadolinium-based contrast agents (GBCAs) may have side effects. Four distinct safety considerations include: acute allergic-like reactions, nephrogenic systemic fibrosis (NSF), gadolinium deposition, and symptoms associated with gadolinium exposure. Acute reactions after GBCA administration are uncommon-far less than with iodinated contrast agents-and, while rare, serious reactions can occur. NSF is a rare, but serious, scleroderma-like condition occurring in patients with kidney failure after exposure to American College of Radiology (ACR) Group 1 GBCAs. Group 2 and 3 GBCAs are considered lower risk, and, through their use, NSF has largely been eliminated. Unrelated to NSF, retention of trace amounts of gadolinium in the brain and other organs has been recognized for over a decade. Deposition occurs with all agents, although linear agents appear to deposit more than macrocyclic agents. Importantly, to date, no data demonstrate any adverse biologic or clinical effects from gadolinium deposition, even with normal kidney function. This article summarizes the latest safety evidence of commercially available GBCAs with a focus on new agents, discusses updates to the ACR NSF GBCA safety classification, and describes approaches for strengthening the evidence needed for regulatory decisions.
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Affiliation(s)
- Jitka Starekova
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Ali Pirasteh
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
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Gordon ER, Trager MH, Adeuyan O, Schreidah CM, Fahmy LM, Lapolla BA, Husain S, Coromilas AJ, Geskin LJ. Alone on a collagen island: Unique findings of osseous sclerotic bodies in nephrogenic systemic fibrosis. JAAD Case Rep 2023; 40:117-119. [PMID: 37766735 PMCID: PMC10520489 DOI: 10.1016/j.jdcr.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
- Emily R. Gordon
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Megan H. Trager
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Oluwaseyi Adeuyan
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Celine M. Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Lauren M. Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Brigit A. Lapolla
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Alexandra J. Coromilas
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Larisa J. Geskin
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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Jiang Z, Xia B, Ren F, Bao B, Xing W, He T, Li Z. Boosting Vascular Imaging-Performance and Systemic Biosafety of Ultra-Small NaGdF 4 Nanoparticles via Surface Engineering with Rationally Designed Novel Hydrophilic Block Co-Polymer. Small Methods 2022; 6:e2101145. [PMID: 35107219 DOI: 10.1002/smtd.202101145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Revealing the anatomical structures, functions, and distribution of vasculature via contrast agent (CA) enhanced magnetic resonance imaging (MRI) is crucial for precise medical diagnosis and therapy. The clinically used MRI CAs strongly rely on Gd-chelates, which exhibit low T1 relaxivities and high risks of nephrogenic systemic fibrosis (NSF) for patients with renal dysfunction. It is extremely important to develop high-performance and safe CAs for MRI. Herein, it is reported that ultra-small NaGdF4 nanoparticles (UGNs) can serve as an excellent safe MRI CA via surface engineering with rationally designed novel hydrophilic block co-polymer (BPn ). By optimizing the polymer molecular weights, the polymer-functionalized UGNs (i.e., UGNs-BP14 ) are obtained to exhibit remarkably higher relaxivity (11.8 mm-1 s-1 at 3.0 T) than Gd-DTPA (3.6 mm-1 s-1 ) due to their ultracompact and abundant hydrophilic surface coating. The high performance of UGNs-BP14 enables us to sensitively visualize microvasculature with a small diameter of ≈0.17 mm for up to 2 h, which is the thinnest blood vessel and the longest time window for low field (1.0 T) MR angiography ever reported, and cannot be achieved by using the clinically used Gd-DTPA under the same conditions. More importantly, renal clearable UGNs-BP14 show lower risks of inducing NSF in comparison with Gd-DTPA due to their negligible release of Gd3+ ions after modification with the novel hydrophilic block copolymer. The study presents a novel avenue for boosting imaging-performance and systemic biosafety of UGNs as a robust MRI CA with great potential in precise diagnosis of vasculature-related diseases.
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Affiliation(s)
- Zhilin Jiang
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
| | - Bin Xia
- School of Chemistry and Chemical Engineering, Anhui Province Key Laboratory of Advanced Catalytic Materials and Reaction Engineering, Hefei University of Technology, Hefei, Anhui, 230009, P. R. China
| | - Feng Ren
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
| | - Bolin Bao
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
- Department of Radiology, Affiliated Hospital 3, Soochow University, Changzhou, 213003, P. R. China
| | - Wei Xing
- Department of Radiology, Affiliated Hospital 3, Soochow University, Changzhou, 213003, P. R. China
| | - Tao He
- School of Chemistry and Chemical Engineering, Anhui Province Key Laboratory of Advanced Catalytic Materials and Reaction Engineering, Hefei University of Technology, Hefei, Anhui, 230009, P. R. China
| | - Zhen Li
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
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Ranga A, Agarwal Y, Garg KJ. Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function. Indian J Radiol Imaging 2021; 27:141-147. [PMID: 28744073 PMCID: PMC5510310 DOI: 10.4103/0971-3026.209212] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.
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Affiliation(s)
- Anju Ranga
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Yatish Agarwal
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanika J Garg
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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Lange S, Mędrzycka-Dąbrowska W, Zorena K, Dąbrowski S, Ślęzak D, Malecka-Dubiela A, Rutkowski P. Nephrogenic Systemic Fibrosis as a Complication after Gadolinium-Containing Contrast Agents: A Rapid Review. Int J Environ Res Public Health 2021; 18:ijerph18063000. [PMID: 33804005 PMCID: PMC8001337 DOI: 10.3390/ijerph18063000] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/22/2022]
Abstract
Introduction: Nephrogenic systemic fibrosis (NFS) is a generalized disorder occurring in people with kidney failure. This new disease entity can lead to significant disability or even death. Gadolinium-associated systemic fibrosis is related to exposure to contrast agents used for magnetic resonance imaging. The aim of this study was to review the literature in available scientific databases on NFS—complication after gadolinium-containing contrast agents. Methods: PubMed and Cochrane Library databases were searched using adequate key words. A literature review of the described cases of NSF occurrence after exposure to gadolinium-containing contrast agents was performed. A review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A review written protocol was not drafted. Results: Originally, 647 studies were searched in scientific databases. After rejecting the duplicate results, 515 results were obtained. Finally, nine studies were included in the review. A total of 173 cases with NSF were included in the analysis. The majority of patients were undergoing dialysis. The contrast agent used for MRI was most often gadodiamide and gadopentetate dimeglumine. The time from exposure to NSF symptoms was from two days to three years. Three authors pointed out other factors in their papers that could potentially influence the occurrence of NSF. These included: metabolic acidosis, ongoing infection, higher doses of erythropoietin and higher serum concentrations of ionized calcium and phosphate. Since 2008, the number of reported cases of NSF has decreased significantly. More recent guidelines and reports indicate that not all contrast agents are associated with the same risk of developing NSF. Conclusions: Most NSF occurs after exposure to linear contrast agents. Therefore, it is recommended to limit their use, especially in dialyzed patients and patients with a GFR < 30 mL/min.
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Affiliation(s)
- Sandra Lange
- Department of Anesthesiology and Intensive Care, Hospitals Tczewskie SA, 30 Stycznia 57, 83-110 Tczew, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing and Intensive Care, Faculty of Health Sciences, Medical University in Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
- Correspondence:
| | - Katarzyna Zorena
- Department of Immunobiology and Environment Microbiology, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Sebastian Dąbrowski
- Department of Medical Rescue, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (S.D.); (D.Ś.)
| | - Daniel Ślęzak
- Department of Medical Rescue, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (S.D.); (D.Ś.)
| | - Anna Malecka-Dubiela
- Department of Internal and Pediatric Nursing, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (A.M.-D.); (P.R.)
| | - Przemysław Rutkowski
- Department of Internal and Pediatric Nursing, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (A.M.-D.); (P.R.)
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Xie J, Haeckel A, Hauptmann R, Ray IP, Limberg C, Kulak N, Hamm B, Schellenberger E. Iron(III)-tCDTA derivatives as MRI contrast agents: Increased T 1 relaxivities at higher magnetic field strength and pH sensing. Magn Reson Med 2021; 85:3370-3382. [PMID: 33538352 DOI: 10.1002/mrm.28664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Low molecular weight iron(III) complex-based contrast agents (IBCA) including iron(III) trans-cyclohexane diamine tetraacetic acid [Fe(tCDTA)]- could serve as alternatives to gadolinium-based contrast agents in MRI. In search for IBCA with enhanced properties, we synthesized derivatives of [Fe(tCDTA)]- and compared their contrast effects. METHODS Trans-cyclohexane diamine tetraacetic acid (tCDTA) was chemically modified in 2 steps: first the monoanhydride of Trans-cyclohexane diamine tetraacetic acid was generated, and then it was coupled to amines in the second step. After purification, the chelators were analyzed by high-performance liquid chromatography, mass spectrometry, and NMR spectrometry. The chelators were complexed with iron(III), and the relaxivities of the complexes were measured at 0.94, 1.5, 3, and 7 Tesla. Kinetic stabilities of the complexes were analyzed spectrophotometrically and the redox properties by cyclic voltammetry. RESULTS Using ethylenediamine (en) and trans-1,4-diaminocyclohexane, we generated monomers and dimers of tCDTA: en-tCDTA, en-tCDTA-dimer, trans-1,4-diaminocyclohexane-tCDTA, and trans-1,4-diaminocyclohexane-tCDTA-dimer. The iron(III) complexes of these derivatives had similarly high stabilities as [Fe(tCDTA)]- . The iron(III) complexes of the trans-1,4-diaminocyclohexane derivatives had higher T1 relaxivities than [Fe(tCDTA)]- that increased with increasing magnetic field strengths and were highest at 6.8 L·mmol-1 ·s-1 per molecule for the dimer. Remarkably, the relaxivity of [Fe(en-tCDTA)]+ had a threefold increase from neutral pH toward pH6. CONCLUSION Four iron(III) complexes with similar stability in comparison to [Fe(tCDTA)]- were synthesized. The relaxivities of trans-1,4-diaminocyclohexane-tCDTA and trans-1,4-diaminocyclohexane-tCDTA-dimer complexes were in the same range as gadolinium-based contrast agents at 3 Tesla. The [Fe(en-tCDTA)]+ complex is a pH sensor at weakly acidic pH levels, which are typical for various cancer types.
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Affiliation(s)
- Jing Xie
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Akvile Haeckel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Hauptmann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christian Limberg
- Department of Chemistry, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nora Kulak
- Institute of Chemistry, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eyk Schellenberger
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Pun PH, Crowley ST. Group II GBCM Can Be Used Safely for Imaging in Stage 4/5 CKD Patients: CON. Kidney360 2020; 2:13-15. [PMID: 35368809 PMCID: PMC8785745 DOI: 10.34067/kid.0005572020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Patrick H. Pun
- Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina,Division of Nephrology, Duke University Medical Center, Durham, North Carolina,Department of Medicine, Durham Veterans Administration Healthcare System, Durham, North Carolina
| | - Susan T. Crowley
- Division of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Medical Services, Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
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Abu-Alfa AK. Group II GBCM Can Be Used Safely for Imaging in Stage 4/5 CKD Patients: COMMENTARY. Kidney360 2020; 2:16-19. [PMID: 35378016 PMCID: PMC8785741 DOI: 10.34067/kid.0006002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 02/04/2023]
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Rodby RA. Group II GBCM Can Be Used Safely for Imaging in Stage 4/5 CKD Patients: PRO. Kidney360 2020; 2:10-12. [PMID: 35368815 PMCID: PMC8785746 DOI: 10.34067/kid.0005792020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/02/2020] [Indexed: 02/04/2023]
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Rudnick MR, Wahba IM, Leonberg-Yoo AK. Use of Gadolinium-Based Contrast Agents in Patients with Severe Renal Impairment. Absence of Risk Versus Caution: A Nephrologist's Perspective. Kidney360 2020; 1:433-435. [PMID: 35368601 PMCID: PMC8809313 DOI: 10.34067/kid.0003022020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Michael R. Rudnick
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ihab M. Wahba
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Philadelphia Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
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13
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Soloff EV, Wang CL. Safety of Gadolinium-Based Contrast Agents in Patients with Stage 4 and 5 Chronic Kidney Disease: a Radiologist's Perspective. Kidney360 2020; 1:123-126. [PMID: 35372905 DOI: 10.34067/kid.0000502019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Erik V Soloff
- Radiology Department, University of Washington, Seattle, Washington
| | - Carolyn L Wang
- Radiology Department, University of Washington, Seattle, Washington
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14
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McWilliams RG, Frabizzio JV, De Backer AI, Grinberg A, Maes BD, Zobel BB, Gottschalk A. Observational study on the incidence of nephrogenic systemic fibrosis in patients with renal impairment following gadoterate meglumine administration: the NSsaFe study. J Magn Reson Imaging 2019; 51:607-614. [PMID: 31287213 DOI: 10.1002/jmri.26851] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Nephrogenic systemic fibrosis (NSF) is a rare life-threatening condition strongly associated with the administration of gadolinium-based contrast agents in patients with severe or endstage renal impairment. PURPOSE To prospectively determine the incidence of NSF in patients with renal impairment after administration of gadoterate meglumine. STUDY TYPE Prospective. POPULATION In all, 540 patients with moderate, severe, or endstage renal impairment, scheduled to undergo a routine contrast-enhanced MRI with gadoterate meglumine. Mean age was 69.7 ± 12.7 years (range: 21-95) with 58.4% of males. FIELD STRENGTH/SEQUENCE 1.5T or 3.0T, sequence according to each site practice. ASSESSMENT Medical history, indication(s) for current MRI and adverse events were recorded for each patient. Patients were followed up over 2 years after administration with three visits separated by at least 3 months to detect any signs/symptoms suggestive of NSF. STATISTICAL TESTS Descriptive. RESULTS Renal impairment was graded as moderate for 69.4% of patients, severe for 16.0% and endstage for 12.1%; 2.6% had undergone a kidney transplant. Estimated glomerular filtration rate ranged from 4 to 59 mL/min/1.73 m2 except one value of 74 mL/min/1.73 m2 in a patient with kidney transplant. Central nervous system exploration was the main MRI indication (34.7%) and mean dose injected was 0.22 ± 0.09 mL/kg. Overall, 446 patients (82.6%) attended at least one follow-up visit and completed the NSF questionnaire and 329 (60.9%) attended the 2-year visit. No suspicion of NSF was reported in all 446 patients, including 119 patients with severe or endstage renal impairment. No deaths and no adverse events were reported during the MRI examination and the usual period of follow-up after gadoterate meglumine administration. DATA CONCLUSION No cases of NSF were observed in the 446 patients with moderate to endstage renal impairment followed up over a maximum of 2 years after injection of gadoterate meglumine. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2020;51:607-614.
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Affiliation(s)
| | | | | | | | - Bart D Maes
- Department of Nephrology, AZ Delta, Roeselare, Belgium
| | - Bruno Beomonte Zobel
- Area of Diagnostic Imaging, Departmental Faculty of Medicine and Surgery, Università "Campus Bio-Medico di Roma,", Rome, Italy
| | - Andreas Gottschalk
- Central Institute for Radiology and Neuroradiology, Krankenhaus Nordwest, Frankfurt am Main, Germany
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Weng Q, Hu X, Zheng J, Xia F, Wang N, Liao H, Liu Y, Kim D, Liu J, Li F, He Q, Yang B, Chen C, Hyeon T, Ling D. Toxicological Risk Assessments of Iron Oxide Nanocluster- and Gadolinium-Based T1MRI Contrast Agents in Renal Failure Rats. ACS Nano 2019; 13:6801-6812. [PMID: 31141658 DOI: 10.1021/acsnano.9b01511] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) are widely used for T1-weighted magnetic resonance imaging (MRI) in clinic diagnosis. However, a major drawback of GBCAs is that they can increase the toxicological risk of nephrogenic systemic fibrosis (NSF) in patients with advanced renal dysfunction. Hence, safer alternatives to GBCAs are currently in demand, especially for patients with renal diseases. Here we investigated the potential of polyethylene glycol (PEG)-stabilized iron oxide nanoclusters (IONCs) as biocompatible T1MRI contrast agents and systematically evaluated their NSF-related risk in rats with renal failure. We profiled the distribution, excretion, histopathological alterations, and fibrotic gene expressions after administration of IONCs and GBCAs. Our results showed that, compared with GBCAs, IONCs exhibited dramatically improved biosafety and a much lower risk of causing NSF, suggesting the feasibility of substituting GBCAs with IONCs in clinical MRI diagnosis of patients with renal diseases.
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Affiliation(s)
- Qinjie Weng
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences , Zhejiang University , Hangzhou 310058 , China
- Center for Drug Safety Evaluation and Research , Zhejiang University , Hangzhou 310058 , China
| | | | - Jiahuan Zheng
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences , Zhejiang University , Hangzhou 310058 , China
| | | | | | | | - Ying Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, and CAS Center for Excellence in Nanoscience , National Center for Nanoscience and Technology of China and University of Chinese Academy of Sciences , Beijing 100190 , China
| | - Dokyoon Kim
- Department of Bionano Engineering , Hanyang University , Ansan 15588 , Korea
- Center for Nanoparticle Research , Institute for Basic Science (IBS) , Seoul 08826 , Korea
| | - Jianan Liu
- Center for Nanoparticle Research , Institute for Basic Science (IBS) , Seoul 08826 , Korea
- School of Chemical and Biological Engineering , Seoul National University , Seoul 08826 , Korea
| | | | - Qiaojun He
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences , Zhejiang University , Hangzhou 310058 , China
| | - Bo Yang
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences , Zhejiang University , Hangzhou 310058 , China
| | - Chunying Chen
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, and CAS Center for Excellence in Nanoscience , National Center for Nanoscience and Technology of China and University of Chinese Academy of Sciences , Beijing 100190 , China
| | - Taeghwan Hyeon
- Center for Nanoparticle Research , Institute for Basic Science (IBS) , Seoul 08826 , Korea
- School of Chemical and Biological Engineering , Seoul National University , Seoul 08826 , Korea
| | - Daishun Ling
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences , Zhejiang University , Hangzhou 310058 , China
- Key Laboratory of Biomedical Engineering of the Ministry of Education, College of Biomedical Engineering & Instrument Science , Zhejiang University , Hangzhou 310058 , China
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16
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Schieda N, Krishna S, Davenport MS. Update on Gadolinium-Based Contrast Agent-Enhanced Imaging in the Genitourinary System. AJR Am J Roentgenol 2019; 212:1223-33. [PMID: 30973785 DOI: 10.2214/AJR.19.21137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE. The purpose of this article is to review gadolinium-based contrast agent (GBCA)-enhanced MRI applications in the genitourinary system. CONCLUSION. Nephrogenic systemic fibrosis is rare or nonexistent with standard dosing of group II GBCAs. Gadolinium retention, cost, and examination times are emerging considerations affecting GBCA use. GBCA is unnecessary to diagnose adrenal adenomas, simple cysts, and some Bosniak category II cysts; however, it is required to determine solid or septal renal mass enhancement. Biparametric prostate MRI requires high-quality and reproducible DWI; therefore, dynamic contrast-enhanced MRI remains valuable in selected prostate MRI examinations.
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17
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Blaha T, Nigwekar S, Combs S, Kaw U, Krishnappa V, Raina R. Dermatologic manifestations in end stage renal disease. Hemodial Int 2018; 23:3-18. [PMID: 30520561 DOI: 10.1111/hdi.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/29/2018] [Indexed: 01/16/2023]
Abstract
Skin manifestations are commonly seen in end stage renal disease (ESRD). Skin involvement in this population can be extensive and dramatically worsen quality of life. Close observation of the skin and nails of ESRD patients by clinicians allows for timely diagnosis and treatment, which ultimately improves quality of life and reduces mortality. In this article we focus on the cutaneous changes most commonly seen in ESRD patients. PubMed/Medline database search was done for published literature on skin manifestations in ESRD patients. All the available literature was reviewed and relevant articles were used to discuss about clinical features, pathogenesis, histology and treatment of each skin disorder in ESRD patients. Most commonly encountered skin manifestations in patients with ESRD are pruritus, xerosis, pigmentation changes, nail changes, perforating disorders, calcifying disorders, bullous dermatoses and nephrogenic systemic fibrosis. Skin manifestations in ESRD can be difficult to treat and multiple comorbidities in this patient population can exacerbate these disorders. Many of the treatment options are experimental with evidence largely derived from the case reports and small clinical trials. More large-scale trials are needed to firmly establish evidence based treatment guidelines. Prompt evaluation and management of these disorders improve morbidity and quality of life in ESRD patients.
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Affiliation(s)
- Taryn Blaha
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Sagar Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara Combs
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Urvashi Kaw
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vinod Krishnappa
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA.,Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General, Akron, Ohio, USA
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18
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol CB, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: A Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can J Kidney Health Dis 2018; 5:2054358118778573. [PMID: 29977584 PMCID: PMC6024496 DOI: 10.1177/2054358118778573] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/31/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE OF REVIEW Use of gadolinium-based contrast agents (GBCA) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCA are absolutely contraindicated in AKI, category G4 and G5 CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), and dialysis-dependent patients is outdated and may limit access to clinically necessary contrast-enhanced magnetic resonance imaging (MRI) examinations. This review and clinical practice guideline addresses the discrepancy between existing Canadian guidelines regarding use of GBCA in renal impairment and NSF. SOURCES OF INFORMATION Published literature (including clinical trials, retrospective cohort series, review articles, and case reports), online registries, and direct manufacturer databases were searched for reported cases of NSF by class and specific GBCA and exposed patient population. METHODS A comprehensive review was conducted identifying cases of NSF and their association to class of GBCA, specific GBCA used, patient, and dose (when this information was available). Based on the available literature, consensus guidelines were developed by an expert panel of radiologists and nephrologists. KEY FINDINGS In patients with category G2 or G3 CKD (eGFR ≥ 30 and < 60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with category G4 or G5 CKD (eGFR < 30 mL/min/1.73 m2) or on dialysis, administration of GBCA should be considered individually and alternative imaging modalities utilized whenever possible. If GBCA are necessary, newer GBCA may be administered with patient consent obtained by a physician (or their delegate) citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, those with category G4 or G5 CKD, or those on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCA. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCA is recommended. LIMITATIONS Limited available literature (number of injections and use in renal impairment) regarding the use of gadoxetate disodium. Limited, but growing and generally high-quality, number of clinical trials evaluating GBCA administration in renal impairment. Limited data regarding the topic of Gadolinium deposition in the brain, particularly as it related to patients with renal impairment. IMPLICATIONS In patients with AKI and category G4 and G5 CKD (eGFR < 30 mL/min/1.73 m2) and in dialysis-dependent patients who require GBCA-enhanced MRI, GBCA can be administered with exceedingly low risk of causing NSF when using macrocyclic agents and newer linear agents at routine doses.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Jason I. Blaichman
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Andreu F. Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
- Neuroradiology Section, MRI Modality Lead, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Québec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Clinical Epidemiology Program and the University of Ottawa, Ontario, Canada
| | | | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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19
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Garcia J, Liu SZ, Louie AY. Biological effects of MRI contrast agents: gadolinium retention, potential mechanisms and a role for phosphorus. Philos Trans A Math Phys Eng Sci 2017; 375:rsta.2017.0180. [PMID: 29038383 PMCID: PMC5647271 DOI: 10.1098/rsta.2017.0180] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/06/2023]
Abstract
No discussion of challenges for chemistry in molecular imaging would be complete without addressing the elephant in the room-which is that the purest of chemical compounds needs to interact with a biological system in a manner that does not perturb normal biology while still providing efficacious feedback to assist in diagnosis of disease. In the past decade, magnetic resonance imaging (MRI) agents long considered inert have produced adverse effects in certain patient populations under certain treatment regimens. More recently, inert blood pool agents have been found to deposit in the brain. Release of free metal is often suspected as the culprit but that hypothesis has yet to be validated. In addition, even innocuous agents can cause painful side effects during injection in some patients. In this brief review, we summarize known biological effects for gadolinium- and iron-based MRI contrast agents, and discuss some of the potential mechanisms for the observed biological effects, including the potential role of phosphorus imbalance, related to kidney disease or cancer, in destabilizing gadolinium-based chelates and precipitating free gadolinium.This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.
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Affiliation(s)
- Joel Garcia
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Stephen Z Liu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Angelique Y Louie
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
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20
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Eckes B, Wang F, Moinzadeh P, Hunzelmann N, Krieg T. Pathophysiological Mechanisms in Sclerosing Skin Diseases. Front Med (Lausanne) 2017; 4:120. [PMID: 28868289 PMCID: PMC5563304 DOI: 10.3389/fmed.2017.00120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/12/2017] [Indexed: 12/19/2022] Open
Abstract
Sclerosing skin diseases represent a large number of distinct disease entities, which include systemic sclerosis, localized scleroderma, and scleredema adultorum. These pathologies have a common clinical appearance and share histological features. However, the specific interplay between cytokines and growth factors, which activate different mesenchymal cell populations and production of different extracellular matrix components, determines the biomechanical properties of the skin and the clinical features of each disease. A better understanding of the mechanisms underlying these events is prerequisite for developing novel targeted therapeutic approaches.
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Affiliation(s)
- Beate Eckes
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - Fang Wang
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - Pia Moinzadeh
- Department of Dermatology, University of Cologne, Cologne, Germany
| | | | - Thomas Krieg
- Department of Dermatology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine (CMMC), Cologne, Germany.,Cluster of Excellence in Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
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21
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Beam AS, Moore KG, Gillis SN, Ford KF, Gray T, Steinwinder AH, Graham A. GBCAs and Risk for Nephrogenic Systemic Fibrosis: A Literature Review. Radiol Technol 2017; 88:583-589. [PMID: 28900045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To examine the risks of using of gadolinium-based contrast agents (GBCAs) in magnetic resonance (MR) imaging and explore strategies to reduce the likeliness of adverse effects in patients who might be at risk for developing nephrogenic system fibrosis (NSF). METHODS A search of 3 scholarly databases was performed to identify articles that discuss adverse reactions to GBCAs, specifically relating to kidney function, in MR examinations. A total of 20 peer-reviewed articles were analyzed. DISCUSSION Safety of contrast media is related to the stability of the chelate bond (ie, macrocyclic or linear). Patients who have decreased kidney function or chronic kidney disease are at higher risk for an adverse reaction to GBCAs; typically, macrocyclic contrast agents are considered safer than linear contrast agents for patients at risk for developing NSF because of their higher kinetic stability. Recommended doses of gadolinium should be adhered to carefully for all patients in conjunction with the glomerular filtration rate guidelines for contrast administration defined by the American College of Radiology. CONCLUSION Although there are advantages to contrast use in MR examinations, technologists should work closely with referring physicians and radiologists to minimize risks for developing NSF in patients who have decreased kidney function.
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22
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Thakor AS, Chung J, Patel P, Chan A, Ahmed A, McNeil G, Liu DM, Forster B, Klass D. Use of blood pool agents with steady-state MRI to assess the vascular system. J Magn Reson Imaging 2017; 45:1559-1572. [PMID: 28422344 DOI: 10.1002/jmri.25636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/02/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past two decades there have been significant advances in the use of magnetic resonance imaging (MRI) to assess the vascular system. New imaging sequences and improvements in magnet design have enabled the creation of higher spatial resolution images. MRI is now a viable alternative imaging modality when compared to both invasive angiography and computed tomographic angiography. The use of blood pool agents has further facilitated the use of MR angiography (MRA); their high molecular weight allows for lower doses of contrast medium administration while their prolonged presence in the blood stream allows for repeated high-quality volumetric imaging of both the arterial and venous circulation. As such, MRA is now no longer constrained by the tight windows for first-pass arterial and venous enhancement, which has resulted in the ability to assess and diagnose a large range of vascular pathologies in both arterial and venous systems. The intent of this review is to highlight MRI findings in common vascular pathologies including peripheral arterial disease (PAD), abnormalities of the abdominal aortic branches, postendovascular aortic aneurysm repair (EVAR) endoleak assessment, popliteal artery entrapment syndrome (PAES), deep venous thrombosis (DVT), vascular thoracic outlet syndrome (TOS), and vascular malformations. In addition, the latest MRI techniques currently used to optimally assess each of these pathologies will be discussed. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;45:1559-1572.
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Affiliation(s)
- Avnesh S Thakor
- Department of Radiology, Lucile Packard and Stanford Hospital, Stanford University, Palo Alto, California, USA
| | - John Chung
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Premal Patel
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chan
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amdad Ahmed
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graeme McNeil
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Liu
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Forster
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Yamamoto J, Kakeda S, Yoneda T, Ogura SI, Shimajiri S, Tanaka T, Korogi Y, Nishizawa S. Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid-induced protoporphyrin IX for high-grade gliomas. Oncol Lett 2016; 13:1269-1275. [PMID: 28454245 DOI: 10.3892/ol.2016.5539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 10/28/2016] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI) with a gadolinium-based contrast agent is the gold standard for high-grade gliomas (HGGs). The compound 5-aminolevulinic acid (5-ALA) undergoes a high rate of cellular uptake, particularly in cancer cells. In addition, fluorescence-guided resection with 5-ALA is widely used for imaging HGGs. 5-ALA is water soluble, while protoporphyrin IX (PpIX) is water insoluble. It was speculated whether converting from 5-ALA to PpIX may relatively increase intracellular water content, and consequently, might enhance the T2 signal intensity in HGG. The aim of the present study was to assess whether 5-ALA-induced PpIX enhances the T2 signal intensity in patients with HGGs. A total of 4 patients who were candidates for HGG surgical treatment were prospectively analyzed with preoperative MRI. Patients received oral doses of 5-ALA (20 mg/kg) 3 h prior to anesthesia. At 2.5 h post-5-ALA administration, T2-weighted images (T2WIs) were obtained from all patients. Subsequently, tumors were evaluated via fluorescence using a modified operating microscope. Fluorescent tumor tissues were obtained to analyze the accumulation of 5-ALA-induced PpIX within the tumors, which was confirmed quantitatively by high-performance liquid chromatography (HPLC) analysis. The MRI T2 signal intensity within the tumors was evaluated prior to and following 5-ALA administration. Three glioblastoma multiformes (GBMs) and 1 anaplastic oligodendroglioma (AO) were included in the analysis. Intraoperatively, all GBMs exhibited strong fluorescence of 5-ALA-induced PpIX, whilst no fluorescence was observed in the AO sample. HPLC analysis indicated a higher accumulation of 5-ALA-induced PpIX in the GBM samples compared with the AO sample. In total, 48 regions of interest were identified within the tumors from T2-WIs. In the GBM group, the relative T2 signal intensity value within the tumors following 5-ALA administration was significantly increased compared with the T2 signal intensity value prior to 5-ALA administration (1.537±0.021 and 1.577±0.023, respectively; P=0.0055). No significant differences were observed in the AO group. These results suggest that the 5-ALA-induced PpIX enhanced the T2 signal intensity in HGG. Therefore, 5-ALA may be a potentially useful MRI contrast reagent for HGG.
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Affiliation(s)
- Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Shingo Kakeda
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Tetsuya Yoneda
- Department of Medical Physics in Advanced Biomedical Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Shun-Ichiro Ogura
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama 226-8501, Japan
| | - Shohei Shimajiri
- Department of Surgical Pathology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | | | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Shigeru Nishizawa
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
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24
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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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25
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Barbieri S, Schroeder C, Froehlich JM, Pasch A, Thoeny HC. High signal intensity in dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in three patients with impaired renal function and vascular calcification. Contrast Media Mol Imaging 2016; 11:245-50. [PMID: 26929131 PMCID: PMC5066707 DOI: 10.1002/cmmi.1683] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022]
Abstract
Gadolinium‐based contrast agents (primarily those with linear chelates) are associated with a dose‐dependent signal hyperintensity in the dentate nucleus and the globus pallidus on unenhanced T1‐weighted MRI following administration to selected patients with normal renal function. The accumulation of gadolinium has also been reported in the skin, heart, liver, lung, and kidney of patients with impaired renal function suffering from nephrogenic systemic fibrosis (NSF). Here we report on three patients with impaired renal function and vascular calcification (two with confirmed NSF) whose unenhanced T1‐weighted MRIs showed conspicuous high signal intensity in the dentate nucleus and the globus pallidus after they had been exposed to relatively low doses of linear gadolinium‐based contrast agents (0.27, 0.45, and 0.68 mmol/kg). Signal ratios between dentate nucleus and pons and between globus pallidus and thalamus were comparable with previously reported measurements in subjects without renal impairment. Of note, all three analysed patients suffered from transient signs of neurological disorders of undetermined cause. In conclusion, the exposure to 0.27‐0.68 mmol/kg of linear gadolinium‐based contrast agent was associated with probable gadolinium accumulation in the brain of three patients suffering from impaired renal function and vascular calcification. © 2016 The Authors. Contrast Media & Molecular Imaging published by John Wiley & Sons Ltd.
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Affiliation(s)
- Sebastiano Barbieri
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Christophe Schroeder
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Johannes M Froehlich
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Andreas Pasch
- Department of Clinical Chemistry, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Harriet C Thoeny
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
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26
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Soulez G, Bloomgarden DC, Rofsky NM, Smith MP, Abujudeh HH, Morgan DE, Lichtenstein RJ, Schiebler ML, Wippold FJ 2nd, Russo C, Kuhn MJ, Mennitt KW, Maki JH, Stolpen A, Liou J, Semelka RC, Kirchin MA, Shen N, Pirovano G, Spinazzi A. Prospective Cohort Study of Nephrogenic Systemic Fibrosis in Patients With Stage 3-5 Chronic Kidney Disease Undergoing MRI With Injected Gadobenate Dimeglumine or Gadoteridol. AJR Am J Roentgenol. 2015;205:469-478. [PMID: 26295633 DOI: 10.2214/ajr.14.14268] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis (NSF) in patients with chronic kidney disease (CKD) and moderate-to-severe impairment of kidney function who had not previously been exposed to gadolinium-based contrast agents (GBCAs) or referred to undergo contrast-enhanced MRI with gadobenate dimeglumine or gadoteridol. SUBJECTS AND METHODS Two multicenter prospective cohort studies evaluated the incidence of unconfounded NSF in patients with stage 3 CKD (estimated glomerular filtration rate [eGFR] in cohort 1, 30-59 mL/min/1.73 m(2)) or stage 4 or 5 CKD (eGFR in cohort 2, < 30 mL/min/1.73 m(2)) after injection of gadobenate dimeglumine (study A) or gadoteridol (study B). A third study (study C) determined the incidence of NSF in patients with stage 4 or 5 CKD who had not received a GBCA in the 10 years before enrollment. Monitoring for signs and symptoms suggestive of NSF was performed via telephone at 1, 3, 6, and 18 months, with clinic visits occurring at 1 and 2 years. RESULTS For studies A and B, the populations evaluated for NSF comprised 363 and 171 patients, respectively, with 318 and 159 patients in cohort 1 of each study, respectively, and with 45 and 12 patients in cohort 2, respectively. No signs or symptoms of NSF were reported or detected during the 2 years of patient monitoring. Likewise, no cases of NSF were reported for any of the 405 subjects enrolled in study C. CONCLUSION To our knowledge, and consistent with reports in the literature, no association of gadobenate dimeglumine or gadoteridol with unconfounded cases of NSF has yet been established. Study data confirm that both gadoteridol and gadobenate dimeglumine properly belong to the class of GBCAs considered to be associated with the lowest risk of NSF.
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Smorodinsky E, Ansdell DS, Foster ZW, Mazhar SM, Cruite I, Wolfson T, Sugay SB, Iussich G, Shiehmorteza M, Kono Y, Kuo A, Sirlin CB. Risk of nephrogenic systemic fibrosis is low in patients with chronic liver disease exposed to gadolinium-based contrast agents. J Magn Reson Imaging 2015; 41:1259-67. [PMID: 24811860 PMCID: PMC5935244 DOI: 10.1002/jmri.24650] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To determine the risk of nephrogenic systemic fibrosis (NSF) in a cohort of patients with chronic liver disease. MATERIALS AND METHODS This retrospective, Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study was performed at a single tertiary liver center. The study cohort comprised 1167 patients with chronic liver disease followed in a liver clinic and exposed to gadolinium-based contrast agents (GBCAs) between February 2004 and October 2007. A retrospective review of medical records was performed. For each patient, data were collected on demographics, history of GBCA exposure, presence of purported risk factors for NSF, and histopathological evidence of NSF. RESULTS Of the 1167 patients with chronic liver disease, 58% (n = 678) had cirrhosis. The patients had a total of 2421 separate GBCA exposures. Fifty-five percent (n = 646) had a single exposure, 19% (n = 218) had two exposures, and 26% (n = 303) had three or more exposures. Seventy-two percent (n = 843) of patients had renal insufficiency, 25 patients (2.1%) had hepatorenal syndrome, 80 patients (6.8%) were in the perioperative liver transplant period, and 49 patients (4.2%) had one or more additional risk factors for NSF. None of the 1167 patients developed NSF. CONCLUSION Chronic liver disease does not appear to be a significant risk factor for NSF.
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Affiliation(s)
- Emmanuil Smorodinsky
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - David S. Ansdell
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Zeke W. Foster
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Sameer M. Mazhar
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Irene Cruite
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
- Department of Radiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Tanya Wolfson
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Sebastian B. Sugay
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Gabriella Iussich
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Masoud Shiehmorteza
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Yuko Kono
- Liver Center, Department of Gastroenterology and Digestive Diseases, University of California, San Diego, San Diego, California, USA
| | - Alexander Kuo
- Liver Center, Department of Gastroenterology and Digestive Diseases, University of California, San Diego, San Diego, California, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA
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Bernstein EJ, Isakova T, Sullivan ME, Chibnik LB, Wolf M, Kay J. Nephrogenic systemic fibrosis is associated with hypophosphataemia: a case-control study. Rheumatology (Oxford) 2014; 53:1613-7. [PMID: 24706993 DOI: 10.1093/rheumatology/keu151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Nephrogenic systemic fibrosis (NSF) is an iatrogenic fibrosing disorder that primarily affects individuals with chronic kidney disease (CKD) following exposure to gadolinium-based contrast agents (GBCAs). Derangements of calcium and phosphorus have been reported in patients with NSF. The aim of this study was to investigate potential factors in addition to GBCA exposure that may be involved in the pathogenesis of NSF. We hypothesized that patients with stage 5 CKD and NSF would manifest greater alterations in calcium, phosphorus and fibroblast growth factor 23 (FGF23) levels than those who do not have NSF. METHODS Levels of phosphorus, calcium, FGF23 and 25-hydroxy-vitamin D were measured in 10 patients with stage 5 CKD and biopsy-proven NSF and in 19 patients with stage 5 CKD without NSF. Statistical analyses were performed using Fisher's exact test for categorical variables and the Kruskal-Wallis test for continuous variables. RESULTS Patients with NSF had significantly lower phosphorus levels compared with controls (P = 0.01). There were no significant differences between NSF patients and controls in calcium, 25-hydroxy-vitamin D, intact parathyroid hormone or FGF23 levels. CONCLUSION Differences in phosphorus metabolism may exist between patients with stage 5 CKD and NSF compared with patients with stage 5 CKD without NSF.
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Affiliation(s)
- Elana J Bernstein
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA.
| | - Tamara Isakova
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA
| | - Mary E Sullivan
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA
| | - Lori B Chibnik
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA
| | - Myles Wolf
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nardone B, Saddleton E, Laumann AE, Edwards BJ, Raisch DW, McKoy JM, Belknap SM, Bull C, Haryani A, Cowper SE, Abu-Alfa AK, Miller FH, Godinez-Puig V, Dharnidharka VR, West DP. Pediatric nephrogenic systemic fibrosis is rarely reported: a RADAR report. Pediatr Radiol 2014; 44:173-80. [PMID: 24057195 DOI: 10.1007/s00247-013-2795-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 07/01/2013] [Accepted: 09/04/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Nephrogenic systemic fibrosis is a fibrosing disorder associated with exposure to gadolinium-based contrast agents in people with severely compromised renal function. OBJECTIVE The purpose of this study was to determine the reported number of cases of nephrogenic systemic fibrosis in children using three distinct publicly available data sources. MATERIALS AND METHODS We conducted systematic searches of the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), the International Center for Nephrogenic Systemic Fibrosis Research (ICNSFR) registry and published literature from January 1997 through September 2012. We contacted authors of individual published cases to obtain follow-up data. Data sets were cross-referenced to eliminate duplicate reporting. RESULTS We identified 23 children with nephrogenic systemic fibrosis. Seventeen had documented exposure to gadolinium-based contrast agents. Six children had been reported in both the FAERS and the literature, four in the FAERS and the ICNSFR registry and five in all three data sources. CONCLUSION Nephrogenic systemic fibrosis has been rarely reported in children. Although rules related to confidentiality limit the ability to reconcile reports, active pharmaco-vigilance using RADAR (Research on Adverse Drug events And Reports) methodology helped in establishing the number of individual pediatric cases within the three major data sources.
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Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH, Herrell SD, Hilton S, Jonasch E, Lin DW, Reuter VE, Chang SS. Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline. J Urol 2013; 190:407-16. [PMID: 23665399 DOI: 10.1016/j.juro.2013.04.121] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this guideline is to provide a clinical framework for follow-up of clinically localized renal neoplasms undergoing active surveillance, or following definitive therapy. MATERIALS AND METHODS A systematic literature review identified published articles in the English literature between January 1999 and 2011 relevant to key questions specified by the Panel related to kidney neoplasms and their follow-up (imaging, renal function, markers, biopsy, prognosis). Study designs consisting of clinical trials (randomized or not), observational studies (cohort, case-control, case series) and systematic reviews were included. RESULTS Guideline statements provided guidance for ongoing evaluation of renal function, usefulness of renal biopsy, timing/type of radiographic imaging and formulation of future research initiatives. A lack of studies precluded risk stratification beyond tumor staging; therefore, for the purposes of postoperative surveillance guidelines, patients with localized renal cancers were grouped into strata of low- and moderate- to high-risk for disease recurrence based on pathological tumor stage. CONCLUSIONS Evaluation for patients on active surveillance and following definitive therapy for renal neoplasms should include physical examination, renal function, serum studies and imaging and should be tailored according to recurrence risk, comorbidities and monitoring for treatment sequelae. Expert opinion determined a judicious course of monitoring/surveillance that may change in intensity as surgical/ablative therapies evolve, renal biopsy accuracy improves and more long-term follow-up data are collected. The beneficial impact of careful follow-up will also need critical evaluation as further study is completed.
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Affiliation(s)
- Sherri M Donat
- American Urological Association Education and Research, Inc., Linthicum, Maryland, USA
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Polasek M, Caravan P. Is macrocycle a synonym for kinetic inertness in Gd(III) Complexes? Effect of coordinating and noncoordinating substituents on inertness and relaxivity of Gd(III) chelates with DO3A-like ligands. Inorg Chem 2013; 52:4084-96. [PMID: 23517079 PMCID: PMC3640422 DOI: 10.1021/ic400227k] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gadolinium chelates with octadentate ligands are widely used as contrast agents for magnetic resonance imaging (MRI), with macrocyclic ligands based on DO3A being preferred for the high kinetic inertness of their Gd chelates. A major challenge in the design of new bifunctional MRI probes is the need to control the rotational motion of the chelate, which greatly affects its relaxivity. In this work we explored facile alkylation of a secondary amine in macrocyclic DO3A-like ligands to create a short, achiral linkage to limit the undesired internal motion of chelates within larger molecular constructs. The acetate moiety on the trans nitrogen was also replaced with either a bidentate (ethoxyacetate, L1 or methyl picolinate, L2) or bulky monodentate (methyl phosphonate, L3) donor arm to give octa- or heptadentate ligands, respectively. The resultant Gd(III) complexes were all monohydrated (q = 1) and exhibited water residency times that spanned 2 orders of magnitude (τM = 2190 ± 170, 3500 ± 90, and 12.7 ± 3.8 ns at 37 °C for GdL1, GdL2, and GdL3, respectively). Alkylation of the secondary amine with a noncoordinating biphenyl moiety resulted in coordinatively saturated q = 0 complexes of octadentate ligands L1 and L2. Relaxivities were limited by slow water exchange and/or lack of water coligand. All complexes showed decreased inertness compared to [Gd(DO3A)] despite higher ligand denticity, and inertness was further decreased upon N-alkylation. These results demonstrate that high kinetic inertness and in vivo safety of Gd chelates with macrocyclic ligands should not be generalized.
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Affiliation(s)
- Miloslav Polasek
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129
| | - Peter Caravan
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129
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Bennett CL, Starko KM, Thomsen HS, Cowper S, Sartor O, Macdougall IC, Qureshi ZP, Bookstaver PB, Miller AD, Norris LB, Xirasagar S, Trenery A, Lopez I, Kahn A, Murday A, Luminari S, Cournoyer D, Locatelli F, Ray P, Mattison DR. Linking drugs to obscure illnesses: lessons from pure red cell aplasia, nephrogenic systemic fibrosis, and Reye's syndrome. a report from the Southern Network on Adverse Reactions (SONAR). J Gen Intern Med 2012; 27:1697-703. [PMID: 22692632 PMCID: PMC3509314 DOI: 10.1007/s11606-012-2098-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 01/06/2012] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
Abstract
Identification of serious adverse drug reactions (sADRS) associated with commonly used drugs can elude detection for years. Reye's syndrome (RS), nephrogenic systemic fibrosis (NSF), and pure red cell aplasia (PRCA) among chronic kidney disease (CKD) patients were recognized in 1951, 2000, and 1998, respectively. Reports associating these syndromes with aspirin, gadodiamide, and epoetin, were published 29, 6, and 4 years later, respectively. We obtained primary information from clinicians who identified causes of these sADRs and reviewed factors contributing to delayed identification of these toxicities. Overall, 3,500 aspirin-associated RS cases in the United States, 1,605 gadolinium-associated NSF cases, and 181 epoetin-associated PRCA cases were reported. Delays in FDA regulation of over-the- counter medications and administration of aspirin to children contributed to development of RS. For NSF, in 1996, the Danish Medicine Agency approved high-dose gadodiamide administration to chronic kidney disease (CKD) patients undergoing MR scans. Overall, 88 % of Danish NSF cases were from two hospitals and 97 % of United States' NSF cases were from 60 hospitals. These hospitals frequently administered high-doses of gadodiamide to CKD patients. Another factor was the decision to administer linear chelated contrast agents versus lower risk macrocyclic chelated agents. For PRCA, increased use of subcutaneous epoetin formulations to CKD patients, in part due to convenience and cost-savings considerations, and a European regulatory requirement requiring removal of albumin as a stabilizer, led to toxicity. Overall, 81, 13, and 17 years elapsed between drug introduction into practice and identification of a causal relationship for aspirin, erythropoietin, and gadodiamide, respectively. A substantial decline in new cases of these sADRs occurred within two years of identification of the offending drug. Clinicians should be vigilant for sADRs, even for frequently-prescribed pharmaceuticals, particularly in settings where formulation or regulatory changes have occurred, or when over-the-counter, off-label, or pediatric use is common.
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Affiliation(s)
- Charles L Bennett
- South Carolina College of Pharmacy, 715 Sumter Street, Suite 311, Columbia, SC, 29208, USA.
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Abstract
Nephrogenic systemic fibrosis (NSF) is a relatively new fibrosing disorder which has caught the attention of various specialities in the past decade. NSF is an extremely disabling and often painful condition, affecting up to 13% of the individuals with chronic kidney disease. The administration of a gadolinium chelate contrast agent has been reported to induce the development of NSF, particularly in patients who have acute or chronic renal disease with a glomerular filtration rate (GFR) lower than 30-mL/min/1.73 m(2) and in those with acute renal insufficiency. Mass spectroscopy studies have demonstrated particles of gadolinium in the lesional tissue. The exact pathogenesis of this curious sclerosing condition is unknown. The role of the aberrant targeting of 'circulating fibrocytes' to the peripheral tissues and viscera has been hypothesized. NSF has distinct clinicopathological features in the setting of renal failure and needs to be looked upon as a new entity on the block. The condition is characterized by irregular indurated plaques, with amoeba-like projections and islands of sparing, chiefly on the trunk and extremities. Flexion contractures of fingers, knees, and elbow joints are known to occur in advanced cases of NSF. The course is frequently associated with painful episodes and loss of ambulation. Histopathology shows haphazard arrangement of thickened bundles of collagen, varying amount of mucin, and increased population of fibroblast-like cells in the dermis. Immunohistochemistry shows increased deposition of type-I procollagen and CD 34+ cells having fibroblastic activity. The condition is refractory to treatment with corticosteroids and immunosuppressive agents. Various modalities of therapy such as UVA1 phototherapy, imatinib mesylate, photodynamic therapy, plasmapheresis, extracorporeal photochemotherapy, and high-dose intravenous immunoglobulin have shown a moderate degree of improvement in skin thickness scores. A prudent option is restoration of renal function to normalcy via renal transplantation but to date the outcome of renal transplantation is unknown.
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Affiliation(s)
- Bhushan Madke
- Department of Dermatology, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai, India
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Abstract
Nephrogenic systemic fibrosis (NSF) has now been virtually eliminated by the discovery of its association with gadolinium-based contrast agents (GBCAs) and the consequent reduced use of GBCA-enhanced magnetic resonance imaging (MRI) in severe renal failure patients. This review of 408 biopsy-confirmed cases shows how to minimize NSF risk when performing GBCA-enhanced MRI or magnetic resonance angiography. The absence of any NSF cases in patients less than 8 years old or greater than 87 years old suggests that infants and elderly patients are already protected. Limiting GBCA dose to a maximum of 0.1 mMol/kg, dialyzing dialysis patients quickly following GBCA administration, delaying administration of GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in renal failure patients, especially when there are pro-inflammatory conditions, appear to have reduced NSF risk to the point where safe GBCA-enhanced MRI is possible in most patients.
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Affiliation(s)
- Zhitong Zou
- Department of Radiology, Weill Medical College of Cornell University, Ithaca, New York, USA; and Chinese Peoples' Liberation Army General Hospital, Beijing, China
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Affiliation(s)
- Harrison W Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Wadas TJ, Sherman CD, Miner JH, Duncan JR, Anderson CJ. The biodistribution of [153Gd]Gd-labeled magnetic resonance contrast agents in a transgenic mouse model of renal failure differs greatly from control mice. Magn Reson Med 2010; 64:1274-80. [PMID: 20648683 PMCID: PMC3180881 DOI: 10.1002/mrm.22553] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 06/02/2010] [Indexed: 12/21/2022]
Abstract
Nephrogenic systemic fibrosis occurs in renally impaired patients who have undergone contrast enhanced MR examination using intravenous gadolinium-based contrast agents. The effect of impaired kidney function on the biodistribution of gadolinium-based contrast agents was investigated using radiolabeled (153/Nat) gadolinium-DOTA, (153/Nat) gadolinium-DTPA, and (153/Nat) gadolinium-DTPA-BMA in a transgenic mouse model of renal impairment. Renally impaired animals had more activity associated with their tissues than did control mice, and this increase varied according to the radiotracer injected. For example, after 7 days, renally impaired animals that received (153/Nat) Gd-DOTA had 3-fold (P < 0.037) more activity in their bone tissue, whereas renally impaired animals receiving (153/Nat) Gd-DTPA and (153/Nat) Gd-DTPA-BMA had 8-fold (P < 0.0001) and 24-fold (P < 0.0001) more activity in their bone tissue, respectively. These findings demonstrate that renal impairment dramatically alters the tissue distribution of Gd(3+) ions in vivo, which are likely a critical factor in the development of nephrogenic systemic fibrosis.
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Affiliation(s)
- Thaddeus J Wadas
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
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Elmholdt TR, Jørgensen B, Ramsing M, Pedersen M, Olesen AB. Two cases of nephrogenic systemic fibrosis after exposure to the macrocyclic compound gadobutrol. NDT Plus 2010; 3:285-287. [PMID: 28657062 PMCID: PMC5477958 DOI: 10.1093/ndtplus/sfq028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 02/18/2010] [Accepted: 02/22/2010] [Indexed: 12/12/2022] Open
Abstract
Nephrogenic systemic fibrosis (NSF) is a disease with progressive fibrosis. We describe two cases of NSF after exposure to a macrocyclic gadolinium-based contrast agent (GBCA) gadobutrol, which has been considered as a low-risk agent compared to linear GBCAs. The first case had chronic kidney disease (CKD) Stage 3 and was exposed to 17.5 ml of gadobutrol. The second case has been exposed twice to GBCA: 10 ml of gadodiamide (in 2001) and 15 ml of gadobutrol (in 2008). Before the second exposure, he had CKD Stage 5 and was in haemodialysis. Both patients have been diagnosed with NSF. Our cases suggest that cyclic GBCAs can also cause NSF.
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Affiliation(s)
- Tina Rask Elmholdt
- MR Research Centre.,Institute of Clinical Medicine.,Department of Dermatology
| | | | - Mette Ramsing
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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Cheong BYC, Muthupillai R. Nephrogenic systemic fibrosis: a concise review for cardiologists. Tex Heart Inst J 2010; 37:508-515. [PMID: 20978560 PMCID: PMC2953218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Nephrogenic systemic fibrosis is a recently recognized disease entity that is potentially debilitating. The exact pathogenesis of nephrogenic systemic fibrosis is unclear, but the disease has been linked with the use of gadolinium-based contrast agents, predominantly in patients with acute renal failure or end-stage renal disease. Consequent to increased physician awareness of this link, the incidence of nephrogenic systemic fibrosis has begun to decrease. The aims of this review are to provide a concise summary of the approved gadolinium-based contrast agents available in the United States, to discuss the postulated pathogenesis of nephrogenic systemic fibrosis, to describe the clinical features of the disease, and to provide broad recommendations for gadolinium-based contrast agent use.
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Affiliation(s)
- Benjamin Y C Cheong
- Department of Radiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Amuluru L, High W, Hiatt KM, Ranville J, Shah SV, Malik B, Swaminathan S. Metal deposition in calcific uremic arteriolopathy. J Am Acad Dermatol 2009; 61:73-9. [PMID: 19406504 PMCID: PMC3622256 DOI: 10.1016/j.jaad.2009.01.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 01/26/2009] [Accepted: 01/29/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Calcific uremic arteriolopathy (CUA) is an often fatal disease that affects patients with end-stage renal disease. Although animal studies support a role for metals in the pathogenesis of CUA, metal accumulation in human tissue has not been previously evaluated. OBJECTIVE We sought to evaluate metal deposition in CUA. METHODS Twelve histologically proven cases of CUA were identified from our dermatopathology database. Five skin biopsy specimens from patients with chronic kidney disease exposed to gadolinium contrast but without CUA were used as controls. Quantification of metals including iron, aluminum, and gadolinium in the lesional skin was performed using inductively coupled mass spectrometry. RESULTS Seven patients had documented exposure to gadolinium-based contrast in the 2 years before CUA. Three of them had concurrent nephrogenic systemic fibrosis. Highly significant quantities of iron (P = .03) and aluminum (P = .0002) were detected in CUA specimens compared with controls. Significant amounts of gadolinium were present in several CUA biopsy specimens. LIMITATIONS Observational, retrospective study design and small sample size are limitations. CONCLUSION Tissue iron and aluminum content is increased in CUA. A significant amount of gadolinium is also present in some CUA specimens. Based on animal studies that strongly implicate metals in the pathogenesis of CUA, our data suggest that metal deposition should be considered in the pathogenesis of human CUA.
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Affiliation(s)
- Lavanya Amuluru
- Division of Nephrology, University of Arkansas for Medical Sciences, 4301 W.Markham St. #501, Little Rock, AR 72205, USA.
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Pao VY, Chang S, Shoback DM, Bikle DD. Hypercalcemia and overexpression of CYP27B1 in a patient with nephrogenic systemic fibrosis: clinical vignette and literature review. J Bone Miner Res 2009; 24:1135-9. [PMID: 19113910 DOI: 10.1359/jbmr.081261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) is a disease of thickened, hard, hyperpigmented skin lesions with or without systemic fibrosis occurring in patients with renal insufficiency and associated with the administration of gadolinium-containing contrast. The pathogenesis of this disease is unclear, and there is no definitive treatment. We describe a 71-yr-old patient with stable chronic lymphocytic leukemia (CLL), end-stage renal disease (ESRD), and NSF who presented with hypercalcemia in 2006. Before onset of renal insufficiency in 2002, serum calcium, phosphorus, and PTH levels were normal. In 2004, the patient began hemodialysis, and he was diagnosed with NSF in 2005, shortly after undergoing an MRI with gadolinium contrast administration. Over the next 6 mo, albumin-corrected serum total calcium levels rose from 9.9 to 13.1 mg/dl (normal range, 8.5-10.5 mg/dl) with normal serum phosphorus levels. On admission in September 2006, 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were elevated at 130.7 pg/ml (normal range, 25.1-66.1 pg/ml). Biopsy of an NSF lesion showed increased 25-hydroxyvitamin D(3)-1-alpha hydroxylase (CYP27B1) immunostaining compared with the biopsy from a normal control. This is the first reported association of NSF with hypercalcemia caused by elevated 1,25(OH)(2)D levels. This metabolic disturbance should be sought in future cases to determine a connection between NSF, 1,25(OH)(2)D metabolism, and CYP27B1 activation in the skin, which may shed light on the pathogenesis of this unusual local and systemic fibrosing disorder.
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Mendichovszky IA, Marks SD, Simcock CM, Olsen ØE. Gadolinium and nephrogenic systemic fibrosis: time to tighten practice. Pediatr Radiol 2008; 38:489-96; quiz 602-3. [PMID: 17943276 PMCID: PMC2292494 DOI: 10.1007/s00247-007-0633-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 07/31/2007] [Accepted: 08/23/2007] [Indexed: 12/23/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) is a relatively new entity, first described in 1997. Few cases have been reported, but the disease has high morbidity and mortality. To date it has been seen exclusively in patients with renal dysfunction. There is an emerging link with intravenous injection of gadolinium contrast agents, which has been suggested as a main triggering factor, with a lag time of days to weeks. Risk factors include the severity of renal impairment, major surgery, vascular events and other proinflammatory conditions. There is no reason to believe that children have an altered risk compared to the adult population. It is important that the paediatric radiologist acknowledges emerging information on NSF but at the same time considers the risk:benefit ratio prior to embarking on alternative investigations, as children with chronic kidney disease require high-quality diagnostic imaging.
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Affiliation(s)
- Iosif A. Mendichovszky
- Radiology and Physics Unit, Institute of Child Health, University College London, London, UK
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Clare M. Simcock
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Øystein E. Olsen
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH UK
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