Personal Injury Law

Gadolinium NSF raises concerns for patients

By Brian F. LaBovick, Esq.

Gadolinium-based contrast agent (GBCA) enables medical specialists to get a clearer picture of abnormal body tissues during the course of an MRI. Gadolinium is a type of metallic ion that moves differently from others in a magnetic field, thus making it an excellent diagnostic aid, but it comes with a huge risk for some patients.

Patients with advanced kidney failure who cannot excrete the chelated form of gadolinium fast enough, nephrogenic systemic fibrosis (NSF) may result. An additional risk factor is acidosis, elevated acid levels in body fluids, a condition often found in end-stage renal patients.

Patients who undergo angioscopic diagnostic procedures may be exposed to up to three times the usual amount of gadolinium. Cardiac patients often have renal insufficiencies due to prolonged elevations in blood pressure. Those most at risk of developing gadolinium NSF are those who have acute or chronic renal insufficiency, often part of the pre-operative stages of a liver transplant.

First noticed in 1997, gadolinium NSF is characterized by a thickening and hardening of skin and connective tissues. Thickened and inflexible skin can interfere with the range of movement in extremities, sometimes resulting in an inability to walk. Internal organs and connective tissue can be seriously damaged, impinging on the function of organs or restricting the movement of areas like the diaphragm, key in the breathing mechanism. Damage may begin appearing within two days to 18 months. Extensive organ damage may result in death.

The first strong association between the use of GBCA and NSF was described in a Danish Medicines Agency press release in May 2006.

In 2007, Yale University's Dr. Phillip Kuo, MD, PhD, a world-renowned expert on NSF, and his colleagues began recommending hemodialysis of kidney patients with a few hours of undergoing a gadolinium-assisted MRI procedure. Kuo recommended at least two sessions of hemodialysis with the first 24 hours of this particular diagnostic test. In subsequent reports, a renal transplant was shown to arrest or even partially reverse the ravages of NSF.

In order to alert physicians to the hazards associated with gadolinium, the U.S. Food and Drug Administration began asking manufacturers in 2009 to include warnings on their gadolinium-based product labels.

Full post as published by LaBovick Injury Law Blog on August 29, 2009 (boomark / email).