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Gadolinium Causes Nephrogenic Systemic Fibrosis in Patients Undergoing Dialysis

By October 31, 2007July 18th, 2019Drug Safety

Gadolinium a contrast used in MRI’s can cause nephrogenic systemic fibrosis and kidney failure. NSF is a tightening and swelling of the skin and other organs, including the lungs and heart. The American Journal of Dermatopathology, suggest a possible explanation for why some patients on kidney dialysis who are injected with a “contrast agent” during a magnetic resonance imaging (MRI) develop nephrogenic systemic fibrosis (NSF).
The U.S. Food and Drug Administration now requires a warning about the potential risk on the products’ labels. NSF leads to thickened, rough or hard skin usually on the arms, legs or trunk. In some cases, the limbs can become difficult or even impossible to move.
It has not been known what causes NSF, but a risk factor is exposure to gadolinium, an agent injected into patent’s veins during some MRI procedures to help improve the visibility of internal organs during the test. The condition occurs in about 2 percent to 4 percent of kidney patients on dialysis who are exposed to gadolinium.
The researchers tested the hypothesis that TG2 may be involved in the response. The enzyme is found throughout the body and is involved in blood clotting and wound healing. They hypothesized that gadolinium may activate the enzyme and cause NSF.
The group obtained skin biopsies from five people with NSF and three healthy people. All NSF patients had renal failure and had previously had imaging procedures using gadolinium. The researchers tested for the presence of TG2 in the skin samples.
“Compared to the healthy subjects, there was a marked increase in TG2 in the subjects with NSF,” said Sane. “This suggests that activation of TG2 can produce the syndrome. TG2 is expressed in virtually all tissues and may explain why the fibrosis can occur in the heart and lungs, as well as the skin.”