Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents.
OBJECTIVE
The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors.


METHODS
This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated.


RESULTS
Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 +/- 15.5 ml (range 15-60 ml) or 0.24 + 0.12 mmol/kg (range 0.1-0.53 mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60 ml/min/1.73 m(2)). Mean eGFR pre-angiography was 26 ml/min/1.73 m(2) and 33 ml/min/1.73 m(2) post-angiography. The mean follow-up period covers 28 months, range 1-84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF.


CONCLUSIONS
Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO(2) angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients.
Hoppe
Hanno
H
Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010 Bern, Switzerland. hanno.hoppe@insel.ch
Spagnuolo
Sara
S
Froehlich
Johannes M
JM
Nievergelt
Helga
H
Dinkel
Hans-Peter
HP
Gretener
Silvia
S
Thoeny
Harriet C
HC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA