title: Clinical manifestation of gadodiamide-related nephrogenic systemic fibrosis.
abstract: OBJECTIVE
  To further characterize the clinical signs and symptoms of nephrogenic systemic fibrosis, a new and serious disease affecting renal failure patients and caused by some Gd-containing contrast agents, including gadodiamide.
  
  
  METHODS
  22 cases of gadodiamide-related nephrogenic systemic fibrosis followed at the nephrology department of Copenhagen University Hospital Herlev.
  
  
  METHODS
  Retrospective cohort study based on medical records, personal interviews and physical examinations.
  
  
  RESULTS
  Typical first signs of the disease were skin discoloration, induration and warmth, itching, constant pain and other neuropathic symptoms localized to the lower legs. First sign appeared in a median of 14 days (range 0 â 53 days) after gadodiamide exposure. Associated early symptoms included sleeplessness and transient, diffuse hair loss. The predominant late symptom was symmetrical skin stiffness of extremities with or without restricted joint motion. Ten of 22 patients (45, 95% CI: 27 â 66%) were severely disabled due to contractures on the average of 29 months after being exposed to gadodiamide. Four patients died (18, 95% CI: 6 â 41). Patients perceived that intensive physiotherapy was effective in limiting disabling contractures.
  
  
  CONCLUSIONS
  Signs and symptoms of nephrogenic systemic fibrosis vary over time and between patients. The disease leads to severe disability in a significant proportion of affected patients. Intensive physiotherapy may limit the development of contractures.
authors.affiliation: Department of Nephrology, Copenhagen University Hospital Herlev, Denmark. peter.marckmann@dadlnet.dk
authors.forename: P
authors.initials: P
authors.lastname: Marckmann
authors.forename: L
authors.initials: L
authors.lastname: Skov
authors.forename: K
authors.initials: K
authors.lastname: Rossen
authors.forename: H S
authors.initials: HS
authors.lastname: Thomsen
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis / Q000139:chemically induced; D005500:Follow-Up Studies; D019786:Gadolinium DTPA / Q000008:administration & dosage / Q000009:adverse effects*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA