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NDT Advance Access first published online on September 19, 2009
This version published online on October 5, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp494
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


NSF after Gadovist exposure: a case report and hypothesis of NSF development

Helmut Wollanka1, Werner Weidenmaier2 and Cecylia Giersig3

1 SRH Hospital Karlsbad-Langensteinbach Ltd, Centre for Neurology and Early Rehabilitation, Academic Hospital at Heidelberg University, Heidelberg 2 Radiology and Nuclear Medicine, Mühlacker 3 Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany

Correspondence and offprint requests to: Cecylia Giersig; E-mail: giersig{at}bfarm.de



  Abstract

So far no cases of nephrogenic systemic fibrosis (NSF) have been published on macrocyclical gadolinium-based contrast media (Gd-CM), assumed as low NSF risk CM due to their complex stability. In our haemodialysis-dependent patient, the first symptoms indicating NSF appeared about 16 months after the exposure to Gadovist, a macrocyclical Gd-CM, and 1 month after x-ray angiography with iodinated CM (Ultravist). This indicates that in addition to excretory renal failure and Gd-CM exposure, the loss of biosynthetic renal function could be essential for NSF development. A hypothesis of possible pathways involved in the development of NSF is presented.

Keywords: FGF23-Klotho axis; hypothesis of NSF development; macrocyclical gadolinium-based contrast media; NSF; case report

The original version was incorrect. The word macrocyclical has been removed from the Background section.

Received for publication: 29. 7.09
Accepted in revised form: 24. 8.09


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