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Gadolinium Warning for People with Kidney Disease

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Updated September 12, 2011

This is an important notice for people with kidney disease that have either been diagnosed with multiple sclerosis (MS) or suspected to have MS (or, conversely, someone with MS who is suspected of having kidney disease).

People with kidney disease are at risk for developing a potentially fatal disease called nephrogenic systemic fibrosis (NSF). Exposure to gadolinium by people with kidney disease increases likelihood of developing NSF by 30 times.

What is Gadolinium?

Gadolinium is a contrast agent used in MRI scans to detect active lesions (often referred to as Gd+ lesions) in people with MS.

What is NSF?

NSF is characterized by a thickening and hardening of the skin, which usually affects arms and legs but can also damage internal organs. It is a very rapidly progressing disease and people can become immobilized and confined to a wheelchair within weeks. Currently there is no treatment for NSF.

The signs and symptoms of NSF include:

  • Skin: Burning, itching, red or dark patches, swelling, hardening, or tightening
  • Eyes: Yellow raised spots on the whites of the eyes
  • Joints/Muscles: Joint pain or stiffness; limited range of motion in arms, hands, legs or feet; pain in the hips or ribs; muscle weakness

Who Is Affected?

This warning applies to people with kidney dysfunction severe enough that they need dialysis. It also applies to anyone who has recently received a liver transplant.

What Should Be Done?

People with with severe kidney dysfunction should have a discussion about the risk versus benefit of this test with his or her neurologist and nephrologist. If the benefit of MRI outweighs the risk, MRI can be performed followed by dialysis within 24 hours.

Make sure that your neurologist (and any other doctor you may see) is aware of your kidney problems. When you go for any MRI, make sure to indicate kidney dysfunction on the intake forms. Also:

  • Kidney disease patients who have had scans involving gadolinium should receive immediate dialysis.
  • They should also subsequently receive regular skin examinations.

Important Points

  • There have been NO reports of NSF in people with normal kidney function or mild to moderate kidney disease after exposure to gadolinium. Most of the patients who developed NSF were receiving dialysis.
  • There are five different gadolinium-based contrast agents (Magnevist, MultiHance, Omniscan, OptiMARK and ProHance). NSF has been reported after all of them.
  • The risk of NSF seems to increase based on the exposure to gadolinium, meaning it is higher in people that have had multiple scans.

Sources:

Preidt, Robert. New Kidney Disease Can Be Fatal. Health Day. October 5, 2007.

FDA Warning. Information on Gadolinium-Containing Contrast Agents.

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  5. Gadolinium Warning for People with Kidney Disease - MRIs Risks and Kidney Disease

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