An epidemic outbreak of nephrogenic systemic fibrosis in a Danish hospital
An epidemic outbreak of nephrogenic systemic fibrosis in a Danish hospital
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DOI：
10.1016/j.ejrad.2008.01.032
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发表时间：
2008-05-01
影响因子：
3.3
通讯作者：
Marckmann, Peter
中科院分区：
文献类型：
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作者：
Marckmann, Peter
在2002-2006年期间，哥本哈根大学医院Herlev的肾病科经历了肾源性系统性纤维化患者的流行性积累。对这些患者的系统性研究显示，他们在出现症状前均进行了钆双胺增强磁共振检查，并且在暴露于钆双胺时均患有重度肾功能不全（慢性肾脏疾病5期）。除钆双胺暴露外，我们的分析表明，钆双胺累积暴露量增加（即重复暴露）以及离子钙和磷酸盐的血清浓度升高是导致肾源性系统性纤维化风险升高的辅助因素。更高的累积钆双胺暴露量、暴露时更高的促红细胞生成素处方剂量和血液透析患者是与最严重形式的肾源性系统性纤维化相关的三个因素。对患者记录和患者访谈的回顾性审查揭示了肾源性系统性纤维化的症状和临床过程的巨大变异性，但也强调了典型的初始症状是小腿对称肿胀、变色和疼痛，而严重受累患者的典型晚期症状是皮肤增厚、僵硬、挛缩和使人虚弱的残疾。肾源性系统性纤维化是肾功能不全患者的严重医源性疾病，其由某些含Gd造影剂，特别是钆双胺引起。不幸的是，目前还没有有效的治疗方法。因此，预防未来的肾源性系统性纤维化病例至关重要。(C)2008爱思唯尔爱尔兰有限公司保留所有权利。
The nephrological department of Copenhagen University Hospital Herlev experienced an epidemic accumulation of patients developing nephrogenic systemic fibrosis in the period 2002-2006. Systematic studies of these patients revealed that they all had a gadodiamide-enhanced magnetic resonance examination prior to their symptoms, and that they all had severe renal insufficiency (chronic kidney disease stage 5) at the time of their exposure to gadodiamide. Besides exposure to gadodiamide, our analyses indicated that increasing cumulative gadodiamide exposure (i.e. repeated exposures), and higher serum concentrations of ionized calcium and phosphate were cofactors that raised the risk of developing nephrogenic systemic fibrosis. Higher cumulative gadodiamide exposure, higher prescribed erythropoietin dosage at exposure, and being hemodialysis patient were three factors associated with nephrogenic systemic fibrosis in its most severe form. Retrospective reviews of patients records and patient interviews revealed the large variability in symptoms and clinical course of nephrogenic systemic fibrosis, but also highlighted that the typical initial symptoms were symmetric swelling, discoloration and pain of lower legs, whereas the typical late symptoms of severely affected patients were skin thickening, stiffness, contractures, and debilitating disabilities.In conclusion, nephrogenic systemic fibrosis is a serious iatrogenic disease of patients with renal insufficiency caused by some Gd-containing contrast agents, in particular gadodiamide. Unfortunately, there is no proven curative treatment. It is therefore essential that future cases of nephrogenic systemic fibrosis are prevented. (C) 2008 Elsevier Ireland Ltd. All rights reserved.