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The presence of infection at the time of magnetic resonance imaging using gadolinium contrast may predispose patients with renal failure to nephrogenic systemic fibrosis, according to a hospital analysis.
The estimated NSF development rate for infected patients with renal failure was 6.7%, compared with 0.3% for uninfected patients with renal failure—a 33-fold difference that was highly significant.
“If the presence of infection indeed proves to be a risk factor for the development of NSF, then some renal failure patients presently judged to be acceptable risks for MR contrast administration on the basis of the degree of renal failure might be reconsidered as high-risk patients,” wrote Dr. Lauren Goldberg of Moses H. Cone Memorial Hospital, Greensboro, N.C., and Dr. James Provenzale, a radiologist at Duke University, Durham, N.C. (Am. J. Roentgenol. 2008;190:1069–75).
Eight patients with symptoms consistent with NSF between 2002 and 2006 were prospectively identified by the nephrology group. Seven biopsy-proven cases were identified, along with another case involving strong clinical signs and symptoms of NSF without biopsy confirmation.
Seven patients had MRI contrast with gadodiamide (Omniscan, GE Healthcare), at a dose from 0.1 mmol/kg to 0.3 mmol/kg. NSF symptoms began 2 days to 5 months after contrast administration. The sole patient not exposed to gadolinium contrast had end-stage renal disease, breast carcinoma, and calciphylaxis.
All eight patients with NSF noted stiffening and thickening of the hands and lower extremities—often described as woody changes of the skin. Five patients had severe chronic pain, the authors reported.
No single medication was common to all patients with NSF. None had vascular thrombosis. Only one patient had undergone major surgery. Five of the patients had documented infection, including catheter infection, urinary tract infection, bacteremia, pneumonia, cellulitis, and osteomyelitis. Two patients who received gadolinium contrast did not have proinflammatory conditions. The one patient who did not receive gadolinium contrast was also considered not to have a proinflammatory condition.
The researchers estimated that 750 renal-failure patients without documented infection and 75 renal-failure patients with documented infection underwent contrast-enhanced MRI between 2002 and 2006.
“All six patients who were hemodialysis dependent at the time of contrast-enhanced MRI were dialyzed 1 day after gadodiamide administration, suggesting that prompt hemodialysis may not be protective against the development of NSF,” the authors wrote.
The investigators disclosed no conflicts of interest.
The presence of infection at the time of magnetic resonance imaging using gadolinium contrast may predispose patients with renal failure to nephrogenic systemic fibrosis, according to a hospital analysis.
The estimated NSF development rate for infected patients with renal failure was 6.7%, compared with 0.3% for uninfected patients with renal failure—a 33-fold difference that was highly significant.
“If the presence of infection indeed proves to be a risk factor for the development of NSF, then some renal failure patients presently judged to be acceptable risks for MR contrast administration on the basis of the degree of renal failure might be reconsidered as high-risk patients,” wrote Dr. Lauren Goldberg of Moses H. Cone Memorial Hospital, Greensboro, N.C., and Dr. James Provenzale, a radiologist at Duke University, Durham, N.C. (Am. J. Roentgenol. 2008;190:1069–75).
Eight patients with symptoms consistent with NSF between 2002 and 2006 were prospectively identified by the nephrology group. Seven biopsy-proven cases were identified, along with another case involving strong clinical signs and symptoms of NSF without biopsy confirmation.
Seven patients had MRI contrast with gadodiamide (Omniscan, GE Healthcare), at a dose from 0.1 mmol/kg to 0.3 mmol/kg. NSF symptoms began 2 days to 5 months after contrast administration. The sole patient not exposed to gadolinium contrast had end-stage renal disease, breast carcinoma, and calciphylaxis.
All eight patients with NSF noted stiffening and thickening of the hands and lower extremities—often described as woody changes of the skin. Five patients had severe chronic pain, the authors reported.
No single medication was common to all patients with NSF. None had vascular thrombosis. Only one patient had undergone major surgery. Five of the patients had documented infection, including catheter infection, urinary tract infection, bacteremia, pneumonia, cellulitis, and osteomyelitis. Two patients who received gadolinium contrast did not have proinflammatory conditions. The one patient who did not receive gadolinium contrast was also considered not to have a proinflammatory condition.
The researchers estimated that 750 renal-failure patients without documented infection and 75 renal-failure patients with documented infection underwent contrast-enhanced MRI between 2002 and 2006.
“All six patients who were hemodialysis dependent at the time of contrast-enhanced MRI were dialyzed 1 day after gadodiamide administration, suggesting that prompt hemodialysis may not be protective against the development of NSF,” the authors wrote.
The investigators disclosed no conflicts of interest.
The presence of infection at the time of magnetic resonance imaging using gadolinium contrast may predispose patients with renal failure to nephrogenic systemic fibrosis, according to a hospital analysis.
The estimated NSF development rate for infected patients with renal failure was 6.7%, compared with 0.3% for uninfected patients with renal failure—a 33-fold difference that was highly significant.
“If the presence of infection indeed proves to be a risk factor for the development of NSF, then some renal failure patients presently judged to be acceptable risks for MR contrast administration on the basis of the degree of renal failure might be reconsidered as high-risk patients,” wrote Dr. Lauren Goldberg of Moses H. Cone Memorial Hospital, Greensboro, N.C., and Dr. James Provenzale, a radiologist at Duke University, Durham, N.C. (Am. J. Roentgenol. 2008;190:1069–75).
Eight patients with symptoms consistent with NSF between 2002 and 2006 were prospectively identified by the nephrology group. Seven biopsy-proven cases were identified, along with another case involving strong clinical signs and symptoms of NSF without biopsy confirmation.
Seven patients had MRI contrast with gadodiamide (Omniscan, GE Healthcare), at a dose from 0.1 mmol/kg to 0.3 mmol/kg. NSF symptoms began 2 days to 5 months after contrast administration. The sole patient not exposed to gadolinium contrast had end-stage renal disease, breast carcinoma, and calciphylaxis.
All eight patients with NSF noted stiffening and thickening of the hands and lower extremities—often described as woody changes of the skin. Five patients had severe chronic pain, the authors reported.
No single medication was common to all patients with NSF. None had vascular thrombosis. Only one patient had undergone major surgery. Five of the patients had documented infection, including catheter infection, urinary tract infection, bacteremia, pneumonia, cellulitis, and osteomyelitis. Two patients who received gadolinium contrast did not have proinflammatory conditions. The one patient who did not receive gadolinium contrast was also considered not to have a proinflammatory condition.
The researchers estimated that 750 renal-failure patients without documented infection and 75 renal-failure patients with documented infection underwent contrast-enhanced MRI between 2002 and 2006.
“All six patients who were hemodialysis dependent at the time of contrast-enhanced MRI were dialyzed 1 day after gadodiamide administration, suggesting that prompt hemodialysis may not be protective against the development of NSF,” the authors wrote.
The investigators disclosed no conflicts of interest.