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Gadolinium-Induced Fibrosis

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Systemic Fibroinflammatory Disorders

Part of the book series: Rare Diseases of the Immune System ((RDIS))

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Abstract

Nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder, predominantly afflicts individuals with advanced renal dysfunction. NSF has been strongly associated with exposure to gadolinium-based contrast agents (GBCAs), which were once believed to be safe for patients with renal disease. In this chapter, we provide a historical perspective on the appearance and disappearance of NSF, including its histopathology, pathogenesis, and association with GBCA exposure. We also review the development of epidemiologic and experimental data, which support a causative relationship between GBCA exposure and NSF. Based upon this body of evidence, we propose that the name of this condition needs to be changed from NSF to gadolinium-induced fibrosis (GIF), which more accurately reflects the totality of knowledge about this disease. Because of the risk of GIF, the use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this vulnerable patient group has almost completely prevented incident cases of this debilitating condition. Emerging anti-fibrotic agents may provide effective treatment for patients with GIF.

Disclosures

D.J.T. has served as an expert witness for plaintiff and defense teams in legal proceedings related to adverse effects of GBCAs. J.K. reports no relevant potential conflicts of interest.

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Authors and Affiliations

  1. Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Derrick J. Todd MD, PhD

  2. Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA

    Jonathan Kay MD

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  1. Derrick J. Todd MD, PhD
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  2. Jonathan Kay MD
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Correspondence to Jonathan Kay MD .

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  1. Department of Nephrology, University Hospital, Parma, Italy

    Augusto Vaglio

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Todd, D.J., Kay, J. (2017). Gadolinium-Induced Fibrosis. In: Vaglio, A. (eds) Systemic Fibroinflammatory Disorders. Rare Diseases of the Immune System. Springer, Cham. https://doi.org/10.1007/978-3-319-41349-5_15

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  • DOI: https://doi.org/10.1007/978-3-319-41349-5_15

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