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Nephrogene systemische Fibrose (NSF) nach Applikation gadoliniumhaltiger Kontrastmittel bei Shuntpatienten

Fallbericht und Literaturübersicht

Nephrogenic systemic fibrosis (NSF) after administration of gadolinium-based contrast media in AV fistula patients

Review and case report

  • Shuntchirurgie
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Bei der nephrogenen systemischen Fibrose (NSF) handelt es sich um eine sehr seltene, sklerodermieartige Systemerkrankung bei niereninsuffizienten Patienten, die möglicherweise durch gadoliniumhaltige Kontrastmittel ausgelöst wird. Üblicherweise tritt sie spätestens 3 Monate nach der Applikation auf. Zeitintervalle von mehr als 3 Monaten sind extrem selten und deuten auf die Notwendigkeit bestimmter Kofaktoren in der Pathogenese hin.

Wir präsentieren daher den Fall einer 52-jährigen Patientin mit terminaler Niereninsuffizienz seit 25 Jahren, die mehr als 4 Jahre nach Gabe eines gadoliniumhaltigen Kontrastmittels eine NSF entwickelt hat. Anamnestisch auffällig waren bei ihr zudem eine fortgeschrittene Vasosklerose auf dem Boden eines sekundären Hyperparathyreoidismus (HPT) und eines chronisch entzündlichen Geschehens.

Dieser Fall lässt vermuten, dass die Gabe gadoliniumhaltiger Kontrastmittel nicht allein für das Auftreten einer NSF verantwortlich ist. Kofaktoren wie eine akzelerierte Atherosklerose im Rahmen von chronischer Inflammation und sekundärem HPT scheinen eine entscheidende Rolle zu spielen.

Abstract

Nephrogenic systemic fibrosis (NSF) is a rare, etiologically unclear disorder in patients with end-stage renal disease (ESRD) and is possibly caused by gadolinium-based contrast agents. NSF usually develops 2–3 months after application of such agents. Herein we present a case with an extraordinarily long time course, underscoring the requirement of certain cofactors such as chronic inflammation and accelerated atherosclerosis – a common feature in ESRD patients – for NSF development.

A 52-year-old woman with ESRD for 25 years developed NSF more than 4 years after the administration of gadolinium-based contrast media. Remarkable in her past medical history was an advanced vascular sclerosis due to a chronic inflammatory state and a secondary hyperparathyroidism.

This case shows that NSF can occur any time after exposure to gadolinium-based contrast agents, which seem to be a necessary, but not the sole, cause of NSF. A review of the current literature and up-to-date recommendations are also given.

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  1. Medizinische Klinik 1, Abteilung für Nephrologie, HELIOS-Klinikum Wuppertal, Universitätsklinikum Witten/Herdecke, Wuppertal, Deutschland

    S.O. Grebe

  2. Klinik für Diagnostische und Interventionelle Radiologie, HELIOS-Klinikum Wuppertal, Universitätsklinikum Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    P. Haage

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Correspondence to P. Haage.

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Grebe, S., Haage, P. Nephrogene systemische Fibrose (NSF) nach Applikation gadoliniumhaltiger Kontrastmittel bei Shuntpatienten. Gefässchirurgie 12, 449–454 (2007). https://doi.org/10.1007/s00772-007-0549-5

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