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Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents

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Abstract

Purpose

The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors.

Methods

This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated.

Results

Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 ± 15.5 ml (range 15–60 ml) or 0.24 + 0.12 mmol/kg (range 0.1–0.53 mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60 ml/min/1.73 m2). Mean eGFR pre-angiography was 26 ml/min/1.73 m2 and 33 ml/min/1.73 m2 post-angiography. The mean follow-up period covers 28 months, range 1–84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF.

Conclusion

Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO2 angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients.

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Authors and Affiliations

  1. Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland

    Hanno Hoppe, Sara Spagnuolo, Johannes M. Froehlich & Harriet C. Thoeny

  2. Clinic of Dermatology, University Hospital Bern, Bern, Switzerland

    Helga Nievergelt

  3. Institute of Diagnostic and Interventional Radiology, Hospital Landshut, Landshut, Germany

    Hans-Peter Dinkel

  4. Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland

    Silvia Gretener

Authors
  1. Hanno Hoppe
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  2. Sara Spagnuolo
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  3. Johannes M. Froehlich
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  4. Helga Nievergelt
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  5. Hans-Peter Dinkel
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  6. Silvia Gretener
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  7. Harriet C. Thoeny
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Correspondence to Hanno Hoppe.

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Hoppe, H., Spagnuolo, S., Froehlich, J.M. et al. Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents. Eur Radiol 20, 595–603 (2010). https://doi.org/10.1007/s00330-009-1586-0

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  • DOI: https://doi.org/10.1007/s00330-009-1586-0

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