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147426 tn?1317265632

There is little to no risk from the MRI contrast, Gadolinium

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.

http***www.icnfdr.org/

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.

Quix
34 Responses
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382218 tn?1341181487
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.
Helpful - 0
382218 tn?1341181487
I should add that luckily, so far I've never had any reaction to the contrast.  I feel no different after it's been injected.
Helpful - 0
486038 tn?1300063367
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.
~Sunnytoday~
Helpful - 0
195469 tn?1388322888
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.

Heather

Heather
Helpful - 0
195469 tn?1388322888
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:

Magnevist (gadopentetate dimeglumine)
Omniscan (gadodiamide)
OptiMARK (gadoversetamide)
MultiHance (gadobenate dimeglumine)
ProHance (gadoteridol)

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).


Helpful - 0
382218 tn?1341181487
Interesting discussion!


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."




Helpful - 0
147426 tn?1317265632
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.

((HUGS, dear)))

Quix
Helpful - 0
195469 tn?1388322888
Ladies,

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.

I'm off to bed...it's after 11 pm here.

Heather

Helpful - 0
551343 tn?1506830518
Well in the uk there is and never has been any panic over using gadolinium.

I had an MRI on the 19th december with this agent, and wasnt even asked if I had a kidney problem.

When I checked on the Internet about the usage of gadolinium I came up with all information by LAWYERS in the USA encouraging people to sue if they had been damaged by the dye.  

Because of this I spoke to my GP prior to having the MRI and was assured that the usage of Gadolinium had been successfully used for years in the UK with very little effect and only minor reactions.

NDF is a new disease, and someone has put 2x2 to make 10 IMHO.

For MONETARY GAIN.

I even found a website that said gadolinium was a radiation metal.

Helpful - 0
198419 tn?1360242356
Quix,

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.

This is a useful learning discussion.  

Many thanks,
Shell
Helpful - 0
Avatar universal
To Quix & Heather,

Thank you for this very informative discussion.  I must admit I was a little worried about the die when having my MRI.

Now I have been given good info and know the facts.

That's what makes this forum so important to all of us.  Lively discussions that get down to the truth of the matter, and increase our knowledge.

doni
Helpful - 0
Avatar universal
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!!

Cydney
Helpful - 0
Avatar universal
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
me
Helpful - 0
572651 tn?1530999357
Hi Scared,
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.
my best,
Lulu
Helpful - 0
Avatar universal
I was having twitching in my face that could not be explained, so I had a brain MRI, didn't find anything.  I do know they used 13CCs of Magnevist (sp?)
Helpful - 0
572651 tn?1530999357
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 hope this helps,
Lulu

Helpful - 0
Avatar universal
My legs are burning, that is what is bothering me most!  I am terrified, I have had my kidneys checked since the MRI and they are still OK, can I get it with working kidneys?
Helpful - 0
Avatar universal
Sorry, guess I have to post again to click add to watch list, It got removed some how.  
Helpful - 0
572651 tn?1530999357
Dear scared,
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.

rest easy,
Lu
Helpful - 0
372680 tn?1228161610
Great info to add here.

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
Helpful - 0
147426 tn?1317265632
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.

Take care and relax.  

Quix
Helpful - 0
Avatar universal
Thank you and yes, I have some health anxiety, am I that transparent?  
Helpful - 0
Avatar universal
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.
Helpful - 0
667078 tn?1316000935
Anyone get killer headaches in the 24 hour period after MRI? I am not worried about it I just wonder if it is just me.
                                             Alex
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