About the use of the contrast agent, gadolinium, and damage to the kidneys or developing the rare condition of Nephrogenic Sytemic Fibrosis.
Gadolinium is the contrast agent used in MRIs. It has been used for over 25 years. In the last few years there has been a lot of press about the possibility that gad has caused a condition of tissue hardening in the body called Nephrogenic Systemic Fibrosis (Nephrogenic = caused by the kidneys; Systemic = body-wide; Fibrosis = scarring or hardening) also known as NSF.
More than 300,000,000 doses (by best guess-timates) of gad have been used. The FDA has registered only about 300 cases of NSF. There are a few hundred reported from the rest of the world.
There are several law firms keeping the topic in high profile. Next time you see an ad or comment about it, look to see the source. It is often a personal injury law firm.
Now what is the risk here? It certainly is not the 1 in a million that the numbers suggest. The ONLY people who have developed NSF are those who ALREADY have very significant renal disease and renal failure. The majority of the people who have developed NSF have already been on dialysis before the MRI! Even if you just look at people with renal failure that get MRIs with contrast, the risk to them is still very small.
This is important to realize everyone before someone gets the mistaken idea that using the contrast poses a danger to everyone. The contrast agent is not the primary culprit. Healthy kidneys excrete the contrast easily and quickly without any effort or potential harm. In research and sometimes in practice the doctors use "triple-dose" gadolinium to better see the lesions. This is NOT associated with any harm in people with normal kidneys.
The harm may come when the kidneys - which are already damaged - cannot excrete the contrast and it is released to continue circulating in the blood in an ongoing basis. This is the only time that it might do harm, causing a wide spread scarring in tissues in the body. There are many substances in our diets and in our meds that would do damage to us if are kidneys could not filter them out promptly. This kind of problem is not isolated to using gadolinium. People with renal failure must avoid many things from certain food, to certain supplements to certain drugs.
Being dehydrated does not make you more susceptible to a problem with the contrast. You do not need to flush it out.
There has never been shown to be a risk to getting the dye unless you have moderate to severe kidney disease. Even then, the vast majority of the cases of NSF (Nephrogenic Systemic Fibrosis) are associated with certain forms of the dye which are being used less often. It needs to be understood that MOST people even with kidney disease do NOT develop NSF, so the risk even to them is not great. BUT they are the only group at risk.
Gadolinium is not hard on the kidneys. Period. It does not damage the kidneys. Period. People who have had dozens and dozens of MRIs with contrast do NOT suffer kidney damage from it.
Everyone needs to understand that there is a lot of misinformation out there about gad and most of it is wrong.
I have watching the reports and they are not finding cases of NSF from use of gadolinium in people without pre-existing renal disease. If your kidneys are okay your risk is essentially nil - nonexistent.
Here is an excellent site that describes what is known and what is suspected about gadolinium and NSF. It is maintained by a physcian who studies the condition.
If I wasn't clear here, please ask questions. I believe it is important that everyone understand where the risk really is.
I hope this is clear and reassures people. Unless you are in renal failure, there is no information that you suffer any risk from gadolinium.
Thanks for this info. When I read the previous posts on this topic, I wondered why I've never had the kidney function test, pre- and post- gad injection. I would have thought if there were significant risks, such a procedure would be pretty standard. I do review the list of side effects and sign a document agreeing to the treatment each and every time, but never any mention of a blood test. I also complete an exhaustive form asking me all kinds of questions about my medical history, problems with kidneys, whether I have any metal anywhere in my body, am I pregnant, etc etc.etc. It's about 40 questions and all of my answers so far have been "no." So it does appear they are doing a pretty thorough screening prior to the procedure.
thank you. After it's injected i feel a bit funny, which passes after about 2 minutes. I just breathe slowly and I'm fine. :) I've had several MRI's this year, and I'm thankful to know that this is ok... one of my local neuro's had said it was not, but he was not so bright in some areas, i do believe.
Thanks for a good post, Quix.
This was in direct contradiction from what I was just told by the radiologists and nurses at the facility where I just had a follow-up MRI. I was told that I should drink alot of fluid after my MRI to help my kidneys flush out the dye. I was also told by a nurse that each and every patient had to have their kidney function levels checked before injection of contrast dye. Am I not to believe what these people told me about contrast dye and how it's metal components were harmful....that it's difficult for the kidneys to flush the dye out of the system, so it needs to be assisted with plenty of fluids?
I would not informed others on the Forum of what I was just told, if it hadn't of put me in a state of alarm. I also looked this up on the internet and what the doctor's and nurses at the facility told me, is backed up by information on the Internet. I am not making this up.
Here is just one article that I looked at, after I had my lastest MRI with contrast in late December of '08. I have NOT said anything in any threads that I did not hear first hand from the persons doing the MRI's at the hospital facility where I just went. What they told me, alarmed me, so I was passing along the information that I received from medical doctor and nurses. I didn't hear this from any commerical on TV. I swear!
FDA Orders Black Box Warning on Gadolinium Agents
May 23, 2007—The FDA announced today that it is asking manufacturers of gadolinium-based contrast agents to include a black box warning alterting patients to the risk of a potentially fatal disease.
The FDA stated that patients with kidney disease or chronic liver disease are at risk for developing nephrogenic systemic fibrosis, a disease characterized by a thickening of the skin and connective tissues that inhibit their ability to move.
The following gadolinium-based agents are implicated by the warning:
The FDA has been aware of problems with gadolinium since at least June 2006, when the agency warned healthcare professionals about the risk of nephrogenic systemic fibrosis. A subsequent warning was issued in December 2006.
The FDA stated it has received 128 reports of nephrogenic systemic fibrosis in patients who used gadolinium-based agents.
Gadolinium is a metal ion used with patients undergoing magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).
In the FAQ's published by the FDA on this matter, the revised warning re: the use of gad, was targeted at patients in acute renal failure. This is how they explained it:
Q. The information FDA released in December 2006 said that patients with moderate renal insufficiency are at risk for developing NSF. Why has this changed?
A. The December information was based upon reports of NSF among patients with purportedly moderate renal insufficiency. Since issuing the information in December 2006, FDA has received new information regarding these patients. Additional details have clarified that the patients actually were in acute renal failure at the time they received a GBCA. Considering this clarification, FDA has not received reports of NSF among patients with normal renal function or moderate renal insufficiency.
There was a related article publised in 2007 in the NEJM; here's the abstract:
"Nephrogenic systemic fibrosis is a newly described systemic disorder that occurs in patients with renal insufficiency. The functional consequences of nephrogenic systemic fibrosis are often devastating and may be fatal. Since nephrogenic systemic fibrosis develops after exposure to gadolinium-containing magnetic resonance contrast agents in some patients, the Food and Drug Administration recommends avoiding such agents in patients with renal insufficiency. The mechanism by which nephrogenic systemic fibrosis develops after gadolinium exposure remains unknown."
I believe you were given somewhat misleading information. The pharmacology of gadolinium states that it is easily cleared from the body by the kidneys, thus there is no NEED to help them flush it out. There is also no harm in drinking more after the exam.
Yes, there is a warning out on gadolinium, the "Black Box Warning" which is of the most urgent kind. But, the warning is not to use on patients with chronic renal disease, NOT because it further damages the kidneys, but because diseased kidneys cannot clear the metallic ion from the blood.
I have not seen info about chronic liver disease, but I will look.
Now, I believe that you were told to do something unnecessary, but I also believe that it raised a state of alarm in you that is also unnecessary. The radiology department, in my opinion, was telling you this as a CYA maneuver, which is their right as they are the ones who get sued if there are bad consequences.
Nowhere have I seen the medical recommendation to warn patients about extra hydration to flush the ion out. There is NO data to support that the contrast is "hard on your kidneys," because that is just not the case. The person who stated that it is hard for the kidneys to flush out the metal ion, I believe is mistaken. I would like to see any real evidence of this and I will correct my blurb immediately.
I, too, have heard of physicians, nurses and techs giving out warnings about this that indicate they don't have a full understanding of the situation. But, I have encountered that in all areas of medicine. So I don't doubt that you were told this at all and I am glad you saw a need to advise and warn. However, I wanted to make it clear that the "precautions and advice" you were told are not particularly needed and wouldn't solve the problem of NSF. If you don't have kidney disease and, apparently chronic liver disease (I'll look that one up) then there is no risk that has been seen.
The only problem about warning people unnecessarily is that first they say, "Gadolinium is difficult to flash out." The person hears, "Gadolinium is hard on the kidneys." The next person hears and says, "Gadolinium damages the kidneys." The next person worries because they have had half a dozen MRI and fears for their safety.
Heather, you didn't do anything wrong. But I could see the seeds of misunderstanding and unwarranted fear, so I wrote the blurb.
Again, there have been just a few hundred cases here in the US and a few hundred in Europe. They have ALL occurred in people with real real disease.
It is quite reasonable for a radiology department to require a recent evaluation of one's renal and liver status. With a chronic illness and often on many different meds we should all have a "chem panel" periodically.
I didn't mean for you to feel so contradicted. I just wanted the info to be correct medically and to be known in context. Finally, you have every right to respect the warnings and instructions that you were given by your medical caregivers. In most cases, we should all place a higher weight on the advice by our own doctors.
Thank you so much for the updated information on gadolinium dye. I WILL be making a call or personal visit to the MRI facility that I just went too. They need to clear up some information for me and for others that have MRI and MRA testing there.
I am also going to be placing a call to the FDA office in my area, to get more information on this subject, along with their updated information about contrast dye and MRI's. I have too many MRI's (as most of us do with MS) to be misinformed, anywhere along the way.
Thank you for writing this up. It has been brought up quite a few times on the forum, and I did some reading but could not articulate as I only found issues that related directly to renal insufficiency.
Frankly, I would rather have the Gad as a contrast than the radioactive isotopes, or the IV iodine, both of which I have had several times for tests. I have reduced kidney function 65% from surgical procedures, and am not worried in the least. At this point in my life, if I am urinating, my lidneys are working, and that's a good thing LOL
This has been a great discussion, and I have enjoyed every bit of it! Thank you for all of the information. I love this place! I may not write often, but I am lurking!!
If you have a high bilirubin, but no other liver problems
and your kidneys are working fine are you at risk of NSF?
I am terrified I have contracted NSF after MRI with
contrast, my legs have been bothering me and I have a raised spot
on the white of my eye. I also have high blood pressure,
about 120/80. Thank you for any information you can give
I would say no, you are not at risk for NSF, but I am not a medical authority.
There are these persistent concerns about NSF and contrast that are so unfounded, but seem to have a life of their own and won't go away. If you have doubts about this, please talk to your doctor for reassurance.
You don't say why you had the MRI, but I would assume there was already a problem there to be looked at. Can you tell us a little more? Those reasons for the MRI may well be linked with the problems of your legs. I don't have a guess about the spot on your eye.
Also, 120/80 is an acceptable blood pressure range. It is not high, although you are bordering on the prehypertensive side. Hypertensive blood pressure (high) numbers would be 140/90 or higher.
I hope this helps with the anxiety - please tell us more about yourself and let us know how we can help.
I looked at the Magnevist page, the manufacturer is Bayer, and it says that NSF can be diagnosed by deep skin biopsy and histopathology. That sounds rather painful - I would wait it out unless you really feel you have to know if it is or isn't NSF.
From the Bayer website - "Symptoms of NSF may include thickening of the skin, swelling of the lower extremities, redness, pruritus, and burning sensations." From what you have said, there appears to be no reason to believe it is.
I'm sorry but I can't be of anymore help with this question - perhaps someone else out there can add to this. I've not done that much research even though I have had contrast three or four times this year with testing. I'm not concerned about the side effects because my kidneys are fine. It seems to be people who are already experiencing severe kidney problems who experienced these side effects.
How did you learn about NSF and why are you so concerned that you have it? Perhaps those answers will help someone else here with some clues about your legs.
If you remember I'd posted about how my contrast mri had made me tired afterwards; it happens after every contrast mri I've gotten, but never with normal mris. Just an afterthough, no response needed. :P
Hi, I'll try to relieve your mind. I was puzzled that the warning on Gadoliniuk included liver disease, because in all of my reading about NSF I had never seen anything about it.
I finally found the link. People with severe chirhosis of the liver or with sever liver failure (this means very sick people with their liver disease) sometimes develop a secondary type of renal failure. This is called Hepatorenal (liverkidney) syndrome. These people with hepatorenal syndrome are deathly ill. The kidneys really have nothing really wrong with them, but the shutdown of the liver also shuts down blood flow to the kidneys and they begin to fail.
So, if your elevated bilirubin is not due to severe liver disease, you are not at risk for NSF. NSF has never been seen in someone with kidneys that are working well. In fact, the decrease in kidney function must be pretty significant to put you at risk.
I don't see that you have ANY risk at all for NSF, but remember I am not your doctor. This is not the place to make the final determination of that. NSF is very, VERY rare! All of the cases have been in renal failure of either a moderate or a severe degree and most have already been on renal dialysis.
I think you need to get some help for your anxiety. Do you tend to develop these fears about health issues? If so, it can rob you of all of your piece of mind.
I went to the Dr. about my leg pain since one area was red this morning. He doesn't know what it is, called it cellulitis, said he doesn't know what caused it but is pretty sure it is not NSF, was surprised I even knew what that was.
I am wondering though if he doesn't know what it is or what is causing it how can he know it is not NSF exspecially by his own ommission he has never saw it.
You need to put this into perspective. I saw my neurologist last night in the UK. I told him about the concerns and problems with Gadolinium in the USA he was most surprised and has NEVER HEARD of it or a problem with Gadolinium, and all the years of using it etc has never heard of anyone getting ill or even having NSF.
I think sorry to say this, USA has become a suing culture and only one person needs to have got NSF after having an MRI with contrast and bingo everyone is getting it.
NSF is a stand alone illness NOT CAUSED by Gadolinium in general. The only reason why someone having Gadolinium COULD possibly rarely get NSF is because they would have renal failure or severe kidney problems, so the kidney cant flush out the Gad quickly enough and the longer it stays within the body the more chances of someone MAYBE having a problem. There is no proof that Gadolinium causes NSF.
If you GOOGLE systemic fibrosis or NSF YOU will find tons of websites all about it and the majority of the web sites are LAWYERS trawling for customers.
Did you get any medication for your cellulitis?
Like I said in the UK it isnt even a problem. Please try to relax over this you will make yourself ill. Like others have said perhaps the burning and aching in the legs is part of the reason why you saw the GP in the first place?
I had a MRI scan in April this year. The nurse let 2-3 ml of dotarem going into my tissues at a principal teaching hospital in london south east.
I had no immediate reaction, but 2 days later a little dizzy, then my upper arm had a bruise at the site of the injection and a burning pain, which strted in the scapula and rotary cuff. My kidney were normal prior and and after the injection. I went straight to the toilet after the injection, but oculd not go again an hour later, although it became normal as soon as I had a couple of glass of water. 0 days later I started to feel again dizzy, nauseated and crawling pain all over my body. I had a blood test almost a month after the injection, which showed no damage to liver, kidney or thyroid. blood count all normal. I started to feel quite alarmed and went to A&E of the main south east london hospital. the doctor said I may have a trapped nerve. A week later as I felt rather bad and also suddenly depressed, I saw my doctor who reassured me the symptoms would go away. However I developed sudden bruising, even my eyes are itching, my head and face. Before the MRI I had a sort of itchign around my breast which went aroudn my neck and back as well, due to hot weather. Doctor said it was a sort of fungal infection, but 6 days later when I went for the scan, it was gone. I have been in touch with the radiologist who tried to reassure me, but as I said they werenegligent to let some liquid into my vein, they do not wish to communicate with me anymore. I have also contacted the drug manufacturer who is analysing my simptoms but no one is doign any test. I am feeling very down, becuase everybody thinks I am worrying so much that at the end I will feel the symptoms of this NFS diseases as a sycomatic reaction. I am taking vitamin B complex which has helped a bit. My diet is excellent and I have no health other problem.
a week later
I had mra Dec 3 and had the mra because of weight loss, tachycardia, dehydration, feels like cannot drink fluids without feeling like cannot breathe, and my heart would race after eating. After the mra I read all about the nsf and kidney damage on different sites. They gave me come to find out .04 mmol of the gadolinium . I am very freaked out for one I have protein in my urine which could be from dehydration. And I now itch all over 2 weeks after the mra. I feel depressed all the time, I also have a pigmentation mark on my white of eye . Concerned went to eye doctor and she seen a yellow raised spot on the white of my eye. She did not know what nsf is but said she would of guessed it to be some sun damage . Where did the pigmentation come from isn't that an nsf symptom ? I am 42 down to 101 pounds because of not eating much . My g f r two weeks after mra was greater than 60 . I am just freaked out and doctors look at me like I am nuts I am vitamin d deficient, vitamin b deficient, iron level very low at 37 . An anemic so I am wondering if the itching can be from that or do I have nsf ? I feel nervous a little like I cannot sit still I don't know if that is from always worrying if I have nsf or does that dye mess with the nervous system. Why did they give me such a high dosage .04 mmol or 40 cc isn't that extremely high dose ? Thanks to anyone that can give me feed back. This all started actually with the lost of weight back in august when I had ct scan dye then 2 days later became very nauseated so gave me another ct scan more nauseous then dealt with it lost weight then that's when had more trouble and mra Dec 3 now the itchy and short of breathe is driving me nuts ! I know short of breathe could be low iron and anemia I hope and not my organs hardening from nsf. I feel a mess !
People with normal kidney function are having serious symptoms after gadolinium and this is not being recognised by the medical communities in our countries. You need to find your way to a support group for GASF-NSF where others will understand what you are suffering.
can you kindly let me know the site for support? You mentioned that you live in UK. What your experience? Would you be prepared to let your case and mine go public?
To everybody on this forum, if you live in uk, please sign the petition against the use of gadolinium in hospitals.
I too have been poisoned by Gadolinium contrast that is said to be safe. I am having brain fog, fatigue, muscle sharp pains, arms legs, and now tingling. together with unexplained bruising. Please stay away from this contrast unless your life depends on it. had the MRI done 2 months ago... have a long way to go to detox it from system. I hope i win and it doesn't get worst.
This is a very old thread, and some of the information we're seeing comes from unsubstantiated sources or is anecdotal . We'd hate to spread fear and misinformation. If anyone wants to talk about this issue and has updated, valid scientific data (pro or con), please start a new thread.
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NO MORE POSTS, PLEASE.
Went into hospital to have gall bladder, ovary and cyst removed. Surgery was successful and went home two days later, day after being home the vomiting started and continued for a whole day. My husband too me back to th era where the re admitted me to see if something had been nicked during surgery. I couldn't keep anything down...motion and even smells made me sick. They were stumped so they had me drink the drink like always before the test of which I told them I wouldn't be able to keep it down, and I didn't to have the MRI. Long story short, from being dehydrated from vomiting so much then getting the contrast dye, it killed my kidneys making me gain 20lbs
, lungs filled with fluid, had to have renal dialysis Four times, fluid drawn off my lungs and so many more problems. Was in the hospital almost a month.
I am sorry for your issues. The contrast is not as safe as people think. That is why they have all the paper work. I buy a gallon of water when I have contrast. I drink it all as soon as possible after contrast. Surgery would be risky and that is what they used to do.I have had 8 MRIs with contrast and at least 8 CT scans with contrast with no problems.
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