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Nephrogenic Systemic Fibrosis - Essay Example

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Although a relatively new disease, with no reported cases prior to early 1997 (Cowper, 2007), nephrogenic systemic fibrosis (hereinafter NSF) has posed a number of challenges for scholars and health care professionals in terms of identifying the population at risk with precision; recently, however, "There is growing recognition of the association between the use of gadolinium-containing radio contrast agents for magnetic resonance imaging and the serious dermal and systemic disease nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis" (Abraham et al, 2007)…
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Nephrogenic Systemic Fibrosis: Gadolinium in an MRI Environment Although a relatively new disease, with no reported cases prior to early 1997 (Cowper, 2007), nephrogenic systemic fibrosis (hereinafter NSF) has posed a number of challenges for scholars and health care professionals in terms of identifying the population at risk with precision; recently, however, "There is growing recognition of the association between the use of gadolinium-containing radio contrast agents for magnetic resonance imaging and the serious dermal and systemic disease nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis" (Abraham et al, 2007). This connection has offered greater hope for identifying the population at risk; as noted by Cowper, NSF has only occurred in people suffering from kidney disease (2007). That is a useful starting point.
The Federal Drug Administration has issued an alert for health care professionals regarding the use of Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging (2007). The populations most at risk are those suffering from acute or chronic severe renal insufficiency, from acute renal insufficiency of any severity due to the hepato-renal syndrome, and those patients in the peri-operative liver transplantation period. For all of these patients it is recommended that health care professionals simply avoid the use of GBCA; the only exception being when it is determined that the diagnostic information to be obtained is absolutely necessary and unavailable through the use of non-contrast enhanced magnetic resonance imaging.
In addition, as a precautionary measure, it is recommended that health care professionals conduct a screening for all patients for a renal dysfunction by either obtaining a history or carrying out laboratory tests. These screening measures are fundamentally precautionary, however, because "the risk, if any, for developing NSF among patients with mild to moderate renal insufficiency or normal renal function is unknown" (Gadolinium-Based Contrast Agents, 2007). In addition to the aforementioned recommended prohibitions and screening measures, it has also become more important to control the dosages of GBCAs; in fact, "Among the factors that may increase the risk for NSF are repeated or higher than recommended doses of a GBCA" (Gadolinium-Based Contrast Agents, 2007). Because so much is unknown about precise risks, much of the action being taken is precautionary.
There have been some suggestions that GBCA elimination can be sped up for patients receiving hemodialysis when the hemodialysis is administered promptly following the GBCA administration and some data to support this view; it must still be noted, however, that whether hemodialysis can prevent the onset of NSF is not yet know (Gadolinium-Based Contrast Agents, 2007). The primary problem is that it is not yet known whether GBCAs are the sole agents or conditions associated with NSF in patients suffering from renal disease. Despite this lack of certainly, the research data suggests some correlation; for instance there have been published reports noting Gadolinium deposits in the skin of patients suffering from NSF and persuasive data linking GCBAs and NSF in patients with acute or chronic renal disease.
In the final analysis, health care professionals and the Federal Drug Administration have adopted a precautionary approach given the lack of precise answers; although, for example, there have been no reported cases of patients with mild renal disease developing NSF, the literature advocates a proactive approach that includes screening, laboratory tests, and thresholds for administrating GCBAs. Much research remains to be done in this area.
References
Abraham, J. L., Boyd, A. S., Zic, J. A. (2007) Gadolinium deposition in nephrogenic
fibrosing dermopathy J Am Acad Dermatol 10.1016/j.jaad.2006.10.048.
Available at
http://www.eblue.org/webfiles/images/journals/ymjd/YMJD4742_proof.pdf.
Accessed May 28, 2008.
Cowper SE. Nephrogenic Fibrosing Dermopathy [NFD/NSF Website]. 2001-2007.
Available at http://www.icnfdr.org. Accessed May 28, 2008.
Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging (marketed as
Magnevist, MultiHance, Omniscan, OptiMARK, ProHance). (2007). U.S
Food and Drug Administration Center for Drug Evaluation and Research:
Information for Health Care Professionals. Available at
http://www.fda.gov/cder/drug/InfoSheets/HCP/gcca_200705HCP.pdf.
Accessed May 28, 2008.
Questions and Answers on Gadolinium-Based Contrast Agents U.S Food and Drug
Administration Center for Drug Evaluation and Research. Available at
http://www.fda.gov/cder/drug/infopage/gcca/qa_200705.htm. Accessed May
28, 2008. Read More
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