Document Detail


An epidemic outbreak of nephrogenic systemic fibrosis in a Danish hospital.
MedLine Citation:
PMID:  18328659     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The nephrological department of Copenhagen University Hospital Herlev experienced an epidemic accumulation of patients developing nephrogenic systemic fibrosis in the period 2002-2006. Systematic studies of these patients revealed that they all had a gadodiamide-enhanced magnetic resonance examination prior to their symptoms, and that they all had severe renal insufficiency (chronic kidney disease stage 5) at the time of their exposure to gadodiamide. Besides exposure to gadodiamide, our analyses indicated that increasing cumulative gadodiamide exposure (i.e. repeated exposures), and higher serum concentrations of ionized calcium and phosphate were cofactors that raised the risk of developing nephrogenic systemic fibrosis. Higher cumulative gadodiamide exposure, higher prescribed erythropoietin dosage at exposure, and being hemodialysis patient were three factors associated with nephrogenic systemic fibrosis in its most severe form. Retrospective reviews of patients records and patient interviews revealed the large variability in symptoms and clinical course of nephrogenic systemic fibrosis, but also highlighted that the typical initial symptoms were symmetric swelling, discoloration and pain of lower legs, whereas the typical late symptoms of severely affected patients were skin thickening, stiffness, contractures, and debilitating disabilities. In conclusion, nephrogenic systemic fibrosis is a serious iatrogenic disease of patients with renal insufficiency caused by some Gd-containing contrast agents, in particular gadodiamide. Unfortunately, there is no proven curative treatment. It is therefore essential that future cases of nephrogenic systemic fibrosis are prevented.
Authors:
Peter Marckmann
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Publication Detail:
Type:  Journal Article     Date:  2008-03-06
Journal Detail:
Title:  European journal of radiology     Volume:  66     ISSN:  0720-048X     ISO Abbreviation:  Eur J Radiol     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-25     Completed Date:  2008-09-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106411     Medline TA:  Eur J Radiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  187-90     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark. peter.marckmann@dadlnet.dk
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MeSH Terms
Descriptor/Qualifier:
Case-Control Studies
Contrast Media / adverse effects*
Denmark / epidemiology
Disease Outbreaks*
Female
Fibrosis / chemically induced,  epidemiology
Gadolinium DTPA / adverse effects*
Humans
Kidney Diseases / chemically induced*,  epidemiology*
Magnetic Resonance Imaging*
Male
Middle Aged
Prevalence
Retrospective Studies
Skin Diseases / chemically induced*,  epidemiology*
Chemical
Reg. No./Substance:
0/Contrast Media; 122795-43-1/gadodiamide; 80529-93-7/Gadolinium DTPA

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