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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| http://dx.doi.org/10.1093/ndtplus/sfq028 | DOI Listing |
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Article Synopsis
- Since 2006, neuroradiologists have restricted the use of gadolinium-based contrast agents (GBCAs) in patients with chronic kidney disease (CKD) to prevent nephrogenic systemic fibrosis (NSF), significantly reducing its occurrence.
- In 2023-2024, the American Society of Neuroradiology reviewed recent research on GBCA safety to update guidelines for MRI contrast use in CKD patients.
- The ASNR now recommends that Group II GBCAs can be safely used in CKD patients when necessary for diagnosis, and additional safety measures like checking renal function may be relaxed.
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