In 1997, a new class of contrast dyes to enhance magnetic resonance imaging (MRI) tests became available. Gadolinium-based contrast agents (GBCAs) were hailed as the answer to a long-standing dilemma: how to get the superior image quality that was possible with contrast dyes whereas minimising the negative side effects associated with traditional iodine dyes. Gadolinium, a rare earth metal element that is toxic in the body when introduced unprotected, could be used safely as a contrast agent because the gadolinium molecules were bound to other molecules called "chelates" that allowed the gadolinium to pass readily through urine. Unfortunately, in patients whose kidney function was already compromised, the unintended effects proved disastrous. A new syndrome called "nephrogenic systemic fibrosis" (NSF) surfaced almost immediately, afflicting patients with serious, progressive, and potentially life-threatening symptoms while eluding a cure.
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Prevent NSF by talking to your doctor. If you have decreased kidney function, you should always discuss it with your doctor before undergoing any procedure, even a routine test like an MRI. Talk to your doctor specifically about GBCAs and the risk for NSF. Ask for an alternative test that will not require GBCAs.
If you have decreased kidney function and already had an MRI but have no symptoms, you should speak to your doctor. Ask to be tested for gadolinium, because early detection may prevent the onset of painful NSF symptoms. Your doctor will probably order a blood test and may also recommend a deep skin biopsy. This is a test in which numbing medicine will be injected into your skin, a small skin sample will be taken, and the site of the sample will be bandaged up to heal. From these tests, your doctor may be able to determine whether your body contains the gadolinium that should have been eliminated immediately after the MRI.
If you are diagnosed with NSF, you have limited treatment options. The most important thing is to improve your kidney function as quickly as possible, and the way to do this is through dialysis or photopheresis. Dialysis is a procedure where your blood is gradually removed from your body, filtered, and returned to your body. Photopheresis is where your blood is removed from your body, subjected to ultraviolet light, and returned to your body. These procedures are intended to cleanse your blood of toxins, thereby improving kidney function and stemming the progress of NSF. If these therapies do not help, a kidney transplant may be a possible solution. These are the only ways to remove gadolinium from your system.
Symptoms of NSF include painful or itchy skin, bumps on your skin, an orange-peel texture of the skin; swelling of your hands and feet, or pain and muscle weakness in your arms or legs; yellow spots or redness on the whites of your eyes; chest pain; and even hair loss. You may experience decreased mobility as the NSF causes your muscles to tighten and contract. If your symptoms are not treated early and aggressively, you could die of NSF.
Partly because NSF is rare and recent, it has no definitive therapy; but some things have been shown to ease the symptoms. Physiotherapy, in particular swimming and deep tissue massage, has been shown to help stave off the worst tightening and hardening associated with NSF. Some patients have reported improvement with certain medications, including oral steroids like prednisone. Your doctor will be able to research other possibilities. If you are diagnosed with this serious condition, it is important to take charge of your care and to never give up.
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