Gadolinium
Gadolinium is a chemical element in most contrast dyes for magnetic resonance imaging (MRI). Gadolinium is very toxic, but is normally removed by the kidneys before it can spread throughout the body and cause harm. When gadolinium-based contrast agents are used in people with poor kidney function it can cause a painful, debilitating, and sometimes fatal condition called Nephrogenic Systemic Fibrosis (NSF) also referred to as Nephrogenic Fibrosing Dermopathy (NFD).
Nephrogenic Systemic Fibrosis (NSF)
There are no known cases of NSF prior to 1997, the same year that that used gadolinium-based contrast dyes in kidney patients became widespread. Since iodine-based dyes are known to cause kidney damage, gadolinium seemed like a safer option for people whose kidneys were already compromised.
All verified cases of NSF, so far, have occurred in people with impaired renal function. It is a very rare, but awful, condition. The skin tightens, thickens, and hardens. Muscles, tendons, and even internal organs can also be involved. NSF causes immobility and can constrict organs such as the heart to the point that it becomes fatal. NSF causes pain, burning, and itching. Immobility can range from the inability to perform normal daily task, such as brushing your hair, to relying on a wheelchair, to being completely bedridden.
There is no cure for NSF. There are some treatment options. No treatment has been consistently effective. In some patients, improving renal function is the most effective treatment and can stop the progression of and sometimes reverse the condition. Improving renal function can mean a undergoing a kidney transplant.
Symptoms of NSF
NSF typically starts with tightening and swelling of the skin on the arms, legs, hands, and/or feet. The symptoms may take several weeks to fully develop, but can develop very rapidly over a period of just a few days. Symptoms include:
- Tightening and swelling of the skin
- Tightening and contracture of tissues around the joints
- Red or dark patches on the skin
- Skin that feels woody
- Skin texture that looks like an orange peel
- Burning, itching, and sharp pains in the affected areas
- Deep bone pain
- Fluctuating hypertension
- Swelling of the hands and feet with blister-like legions
Gadolinium and the Law
Originally, gadolinium-based contrast dyes were distributed they included an insert that caution should be used in patients with impaired renal function, but there were no warning against their use. In 2007, the Food and Drug Administration (FDA) ordered that the dyes must carry a black box warning stating the people with severe kidney problems could develop NSF. But, even those with moderate kidney problems are at risk.
Omniscan, made by GE is associated with the highest number of NSF cases, but all gadolinium dyes pose a risk. When Danish radiologist Henrik Thomsen spoke out against Omniscan GE filed a libel suit against him in Britain. According to Thomsen, 20 patients at his hospital were permanently wheelchair bound by NSF after receiving injections of Omniscan. Shortly after Thomsen threatened to countersue GE for calling him a liar, GE withdrew its lawsuit against him.
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