Nephrogenic systemic fibrosis: possible association with a predisposing infection.
OBJECTIVE
Infection at time of MR contrast administration has been reported to predispose patients with renal failure to development of nephrogenic systemic fibrosis (NSF). We assessed the frequency of infection at the time of MR contrast administration in a group of NSF patients.


METHODS
Eight patients developed NSF during 2002-2006, of whom seven received the MR contrast agent gadodiamide (Omniscan), with doses of 0.10-0.31 mmol/kg. Data for the following were available for only 2005 and 2006: numbers of infected and uninfected renal failure patients who received MR contrast material and number of contrast-enhanced MR scans in all patients. We extrapolated data to 2002-2006 to approximate rates of NSF in infected and uninfected renal failure patients using Fisher's exact test for association between variables and calculated odds ratios with 95% CIs.


RESULTS
Five of seven NSF patients receiving MR contrast material had infections at the time of contrast administration. Three hundred thirty-four patients with renal failure received MR contrast material in 2005 and 2006 (29 infected). The rate of NSF was 6.7% in infected renal failure patients and 0.26% in uninfected patients. Data extrapolated to 2002-2006 yielded estimates of 75 infected and 750 uninfected renal failure patients. The association of NSF with infection was highly significant (p < 0.001) with an odds ratio of 25 and CI of 3.9-264.4.


CONCLUSIONS
The association of NSF with infection was highly significant, supporting the hypothesis that infection at the time of MR contrast administration in renal failure patients predisposes to NSF.
Golding
Lauren Parks
LP
Department of Internal Medicine, Moses H. Cone Hospital, Greensboro, NC, USA.
Provenzale
James M
JM
D000368:Aged; D001706:Biopsy; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis / Q000139:chemically induced; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced*; D012307:Risk Factors; D012871:Skin Diseases / Q000139:chemically induced*
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA