Nephrogenic systemic fibrosis (NSF) was recently linked to gadolinium-based contrast (GBC) exposure in patients with renal failure. As result, the U.S. Food and Drug Administration (FDA), the UK Commission on Human Medicines (CHM) and the European Pharmacovigilance Working Party Committee for Medicinal Products for Human Use (CHMP) recommended that GBC should be avoided in patients with advanced renal failure (GFR < 30 ml/minute/1.73 m2). Ones initial reaction is to advise avoidance of GBC exposure in patients with any level of kidney disease to prevent this awful complication. However, this approach is not based on data nor is it practical for patients who would benefit from this diagnostic modality. Thus, while complete avoidance cannot currently be advocated, GBC-enhanced MRI in renal impairment should be reserved for neurological and vascular cases where the quality of information gained is sufficient to justify the risk of potential devastating adverse effects of NSF.
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