Nephrogenic systemic fibrosis: Center case review
Nephrogenic systemic fibrosis: Center case review
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DOI：
10.1002/jmri.21136
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发表时间：
2007-11-01
影响因子：
4.4
通讯作者：
Martin, Diego R.
中科院分区：
文献类型：
--
作者：
Lauenstein, Thomas C.;Salman, Khalil;Martin, Diego R.
目的：回顾分析本中心的肾源性全身性纤维化(NSF)病例，通过回顾实验室数据和同期药物治疗，确定先前使用Gad oline造影剂(GBCA)的情况，并评估可能导致NSF发生的常见危险因素。材料和方法：共4个数据库(病理、MRI、透析和医疗记录)用于NSF患者的识别和评估。NSF患者的病史被评估为既往有深静脉血栓形成(DVT)、手术或感染。对实验室数据(肌酐、阴离子间隙、钙磷和白蛋白)以及同时用药进行评估。结果：2003年10月至2007年2月，共有9例非NSF透析患者确诊。所有患者在被诊断为NSF之前都接受了增强MRI检查。我们的MRI中心只使用了一种格拉络合物(Omniscan(R)，加多二胺；GE Health-care)。在9名患者中，有8名在接受MRI扫描时正在接受透析。在同一时间，312名透析患者接受了加多二胺治疗。因此，暴露于加多二胺的透析患者中NSF的患病率为2.6%。NSF患者的内生肌酐和阴离子间隙明显高于对照组。其他化验值以及药物治疗均未显示出显著差异。在NSF组中，没有关于DVT、手术或感染的既往病史的模式。结论：我们的发现与先前报道的加多二胺暴露与NSF之间的关联是一致的。所有NSF患者在最后一次给药时都有严重的肾功能不全，肾小球滤过率(GFR)为<；30(最高GFR=25毫升/分钟)，平均在2.9次给药中接受了71毫升的加多二胺。
Purpose: To retrospectively analyze nephrogenic systemic fibrosis (NSF) cases at our center, to determine prior gad olinium based contrast agent (GBCA) administration and to evaluate possible common risk factors for the development of NSF by reviewing laboratory data and concurrent medications.Materials and Methods: A total of four data bases (pathology, MRI, dialysis, and medical records) were cross-referenced for identification and evaluation of NSF patients. Medical history of NSF patients was assessed as for previous deep venous thrombosis (DVT), surgery, or infections. Laboratory data (creatinine, anion gap, calcium phosphorus, and albumin) as well as concurrent medication were evaluated. Findings were compared to those of a control group of non-NSF dialysis patients.Results: Between October 2003 and February 2007 a total of nine NSF cases were identified. All patients had undergone contrast-enhanced MRI prior to the diagnosis of NSF. Only one gadolinium chelate had been used at our MRI center (Omniscan (R), gadodiamide; GE Health-care). Of nine patients, eight were receiving dialysis at the time of the MRI scan. During the same time 312 dialysis patients received gadodiamide. Thus, the prevalence of NSF within dialysis patients exposed to gadodiamide was 2.6%. NSF patients presented with a higher creatinine and anion gap than the control patients. Other laboratory values as well as medication did not show a significant difference. There were no patterns regarding previous history of DVT, surgery, or infection in the NSF group.Conclusion: Our findings are consistent with the previously reported association between gadodiamide exposure and NSF. All NSF patients had severe renal insufficiency with glomerular filtration rate (GFR) < 30 (highest GFR = 25 mL/minute) at the time of last gadodiamide administration, and on average had received 71 mL of gadodiamide over an average of 2.9 administrations.