Gadolinium-based Magnetic Resonance Contrast Agents and Nephrogenic Systemic Fibrosis
tiny amounts of Gd after intravenous infusion, even in patients with normal renal function.62
Any GdBCA should therefore be used
with caution, and high dosing and frequently repeated exposures should be avoided if possible. Other imaging techniques, such as unenhanced MR and ultrasound, should be used whenever possible, in particular in renal patients.
The NSF story is a classic example of a new epidemic and should remind us all about the need for continued alertness and focus on possible adverse effects of newly introduced clinical practices. It demonstrates
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an unfortunate delay in the warning of the medical community: it took almost a year from the appearance of the first reports linking GdBCAs to NSF until warnings were sent out by medical authorities. This delay may have led to several cases of NSF that might have been otherwise prevented. Hopefully, rethinking of authority practices in response to reports on serious side effects of clinical practices has been initiated by the NSF experience. Whether preclinical testing and reporting practices on the safety of new drugs are sufficient is also worth a thought: with today’s knowledge, it is hard to understand how the Gd toxicity of some of the GdBCAs could have been overlooked. n
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