Radiologic clinics of North America
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Radiol. Clin. North Am. · Sep 2009
ReviewHow to avoid nephrogenic systemic fibrosis: current guidelines in Europe and the United States.
Views vary about how to avoid nephrogenic systemic fibrosis (NSF). In Europe, it is contraindicated to use gadodiamide, gadopentetate dimeglumine, and gadovertisamide in patients who have a glomerular filtration rate (GFR) of less than 30 mL/min, and these agents may only be used with caution in patients who have a GFR between 30 and 60 mL/min. ⋯ In the United States, the US Food and Drug Administration introduced a class ban and warned about the use of gadolinium-based contrast agents in patients who have reduced renal function. However, European and American guidelines about how to avoid NSF are generally not very different.
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Radiol. Clin. North Am. · Sep 2009
ReviewInvolvement of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: an update.
Nephrogenic systemic fibrosis (NSF) is a highly debilitating scleroderma-like disease occurring exclusively in patients with severe or end-stage renal failure. Since the recognition of a link between gadolinium chelates (GCs) used as contrast agents for MR imaging and NSF by two independent European teams in 2006, numerous studies have described the clinical issues and investigated the mechanism of this disease. ⋯ High kinetic stability provided by the macrocyclic structure, combined with high thermodynamic stability, minimizes the amount of free gadolinium released in the body. The current hypotheses regarding the pathophysiologic mechanism are critically discussed.