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MRI NSF: Patients with Renal Insufficiency at Risk

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Des Moines, IAIt has only been in the past 10 years or so that MRI contrast side effects have become more widely known, specifically the risks associated with the use of certain MRI contrast agents in patients with kidney failure. In some patients, MRI health risks include a risk of developing nephrogenic systemic fibrosis (NSF), a potentially fatal condition with no known treatment.

Nephrogenic systemic fibrosis was initially called nephrogenic fibrosing dermopathy (NFD) because it was thought to only affect the patient's skin cells. As the disease has become more widely studied, medical professionals have observed that the disease also affects internal organs, leading to the name change.

The disease was first described in 2000 and has since been linked to the use of gadolinium-based contrast agents in patients with renal insufficiency. Patients who develop NSF usually first experience a hardening and hyperpigmentation of the skin, often around the legs and arms. As the skin hardens, the patient experiences difficulty moving joints, such as knuckles, elbows and knees.

As the NSF progresses, the patient may eventually require a wheelchair because regular movements become almost impossible. Nephrogenic systemic fibrosis can also cause fibrosis (the formation of excessive fibrous tissue) around the patient's organs, which can be fatal.

Patients at risk for NSF are those who have had an MRI with a contrast agent that contains gadolinium and who also have kidney insufficiency, such as acute kidney injury or chronic kidney disease. Furthermore, there is evidence that higher than recommended doses of the gadolinium-based contrast agents or repeated doses of the contrast agents could increase the risk of developing NSF.

Symptoms of NSF include pain, burning or itching sensations, changes in skin tone including a reddish tone or dark patches, edema, skin feeling more firm, joint stiffness, joint pain, weakness or limited motion in the limbs. According to the US Food and Drug Administration (FDA), patients who are about to receive a gadolinium-based contrast agent (GBCA) should be screened for acute kidney injury or chronic kidney disease prior to receiving the contrast agent.

Patients who have acute kidney injury or chronic kidney disease should not be given three specific GBCA drugs—Magnevist, Omniscan or Optimark—according to the FDA.

So far, NSF has not been reported in patients with normal kidney function.

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