title: Gadolinium-Induced Fibrosis.
abstract: Gadolinium-based contrast agents (GBCAs), once believed to be safe for patients with renal disease, have been strongly associated with nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder that predominantly afflicts individuals with advanced renal dysfunction. We provide a historical perspective on the appearance and disappearance of NSF, including its initial recognition as a discrete clinical entity, its association with GBCA exposure, and the data supporting a causative relationship between GBCA exposure and NSF. On the basis of this body of evidence, we propose that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease. Use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this population has almost completely eradicated new cases of this debilitating condition. Emerging antifibrotic therapies may be useful for patients who suffer from GIF.
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.|Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts 02115.
authors.forename: Derrick J
authors.initials: DJ
authors.lastname: Todd
authors.affiliation: Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts 01605; email: jonathan.kay@umassmemorial.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kay
mesh_terms: D000818:Animals; D003287:Contrast Media / Q000009:adverse effects* / Q000378:metabolism; D005682:Gadolinium / Q000009:adverse effects* / Q000378:metabolism; D019786:Gadolinium DTPA / Q000009:adverse effects; D006571:Heterocyclic Compounds / Q000009:adverse effects; D006801:Humans; D008536:Meglumine / Q000009:adverse effects / Q000031:analogs & derivatives; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D009942:Organometallic Compounds / Q000009:adverse effects; D009626:Terminology as Topic
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C073590:gadolinium ethoxybenzyl DTPA; C062402:gadoteridol; C064572:gadobenic acid; C090600:gadobutrol; D008536:Meglumine; C064925:gadodiamide; D005682:Gadolinium; D019786:Gadolinium DTPA; C072417:gadoterate meglumine; C112666:gadoversetamide; C109932:gadofosveset trisodium
keywords: Gd; chronic kidney disease; fibrosing disorders; gadolinium-based contrast agents; magnetic resonance imaging; nephrogenic systemic fibrosis