Different time courses of nephrogenic systemic fibrosis: Is there a role for pharmacokinetic aspects in explaining a new clinical entity?
OBJECTIVE
To report 3 cases of nephrogenic systemic fibrosis (NSF) focussing on the time course of clinical symptoms after exposure to gadolinium based contrast agents (GBCA) and to discuss pharmacokinetic aspects of commercially available GBCA. PATIENTS' DETAILS: All 3 patients (2 men, 1 woman, aged 51 - 54 years) suffered from end-stage renal disease (ESRD) and were on long-term dialysis. Linear GBCA compounds were given to all patients and NSF symptoms started 6 months, 1 and 4 years after the last GBCA exposure. In 2 patients, GBCA was administered after the occurrence of (unrecognized) NSF symptoms leading to worsening of clinical courses. 1 of the patients received multiple therapies (e.g. UV-A1 treatment, physical therapy) without significant improvement, 2 patients died from cardiac complications shortly after the diagnosis of NSF.


CONCLUSIONS
NSF may develop after a longer period of time than generally reported and GBCA administration may aggravate or accelerate chronic, subclinical NSF symptoms.
Schmiedl
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Philipp Klee-Institute of Clinical Pharmacology, HELIOS Klinikum Wuppertal, University Witten/Herdecke, Germany. sven.schmiedl@helios-kliniken.de
Wesselmann
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Lehmann
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Haage
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Grebe
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D003287:Contrast Media / Q000009:adverse effects* / Q000493:pharmacokinetics; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced / Q000503:physiopathology*; D006435:Renal Dialysis; D013997:Time Factors
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA