Future DirectionGadolinium deposition disease: Initial description of a disease that has been around for a while
Introduction
Gadolinium related toxicity has been recognized for at least 10 years, with the initially described condition being nephrogenic systemic fibrosis (NSF). NSF is a debilitating and potentially life-threatening disease that was first recognized in 1997 in 15 dialyzed patients and later described in 2000 [1]. Almost a decade later, the association between the described changes and the administration of Gadolinium-based contrast agents (GBCAs) was established by groups of nephrologists, initially Grobner et al. [2] and subsequently Marckmann et al. [3]. The combination of limiting or avoiding the use of GBCAs in subjects with advanced renal failure and employing more stable GBCAs greatly reduced the incidence of this disease with no new cases reported after 2009 [4].
This led many to believe that: 1) the most stable GBCAs were extremely safe and did not cause disease, and 2) subjects with normal renal function did not develop gadolinium related toxicity. However, patients with normal renal function have described severe disease that arose shortly after the administration of GBCAs [5], [6]. A first description of a presumed toxicity related to GBCA administration has been recently published [5]. It appears that patients with normal renal function may exhibit severe symptomatology, beyond the time frame of severe acute adverse events, related to the administration of GBCAs [7]. The purpose of our study was to access patients who report severe symptomatology following GBCA administration, to assess the various manifestations and to attempt to identify which GBCAs may be most responsible for the disease.
Section snippets
Methods
Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act (HIPAA) – compliant prospective study. The survey was anonymous and all participants were recruited from online gadolinium toxicity support groups. All participants of the survey were informed of the purpose of the study. An electronic link to the survey was posted to a private blog [8] (MRI-Gadolinium-Toxicity support group) that discusses gadolinium toxicity, and a public Gadolinium
Results
Forty-two participants responded to this survey (27 women, 14 men; and 1 participant did not specify). Forty were Caucasian white and 2 were Hispanic white.
One participant reported history of renal insufficiency. This patient reported a remote history of renal insufficiency, which preceded the inciting MRI. At the time of the inciting MRI, the patient had normal renal function. The age of onset ranged from 28 to 69, mean 49.1 ± 22.4 years.
Forty-one participants had evidence of gadolinium presence
Discussion
Our results show that many of the respondents' reported signs and symptoms are consistent among subjects, and include various findings similar, but less severe than found in NSF [10]. Based on these results, we propose a name for this presumed disease process in subjects with normal renal function and gadolinium toxicity, Gadolinium Deposition Disease (GDD). At least 60% of our subjects showed a glove-and-sock distribution of disease associated with intense sharp “pins and needles” or burning
References (24)
- et al.
Scleromyxoedema-like cutaneous diseases in renal-dialysis patients
Lancet
(2000) - et al.
Self-reported gadolinium toxicity: a survey of patients with chronic symptoms
Magn Reson Imaging
(2016) - et al.
Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis – setting the record straight
Semin Arthritis Rheum
(2006) Nephrogenic systemic fibrosis: a review and exploration of the role of gadolinium
Adv Dermatol
(2007)- et al.
Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis
J Am Acad Dermatol
(2011) Gadolinium – a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis?
Nephrol Dial Transplant
(2005)Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging
J Am Soc Nephrol
(2006)- et al.
Nephrogenic systemic fibrosis: change in incidence following a switch in gadolinium agents and adoption of a gadolinium policy – report from two U.S. universities
Radiology
(2009) - et al.
Gadolinium-based contrast agent accumulation and toxicity: an update
Am J Neuroradiol
(2015) A survey of the chronic effects of retained gadolinium from contrast MRIs
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