GBCA is used as a contrast agent for MRI procedures.
Patients at risk:
(1) acute or chronic renal insufficiency with GFR < 30 mL per min per 1.73 sq m
(2) acute renal dysfunction associated with the hepatorenal syndrome
(3) acute renal dysfunction in the perioperative liver transplant period
Clinical findings:
(1) burning or itching of the skin
(2) erythematous or darkened patches of skin
(3) skin swelling
(4) skin hardening or tightening
(5) yellow spots on the conjunctiva
(6) joint stiffness with limited range of motion
(7) joint or bone pain
(8) muscle weakness
Skin biopsy can demonstrate the fibrosis.
The fibrosis may involve internal organs, resulting in dysfunction and death.
Risk factors associated with GBCA use:
(1) multiple doses
(2) high doses
Hemodialysis removes the GBCA but it is unknown if this alters the risk for NSF.
Recommendation: Avoid the use of a gadolinium-based contrast agent in a patient with risk factors for NSF unless the information obtained is critical AND cannot be obtained by any other method.
