Department of Radiology, Medical University of Vienna, Vienna, Austria.
Eur J Radiol. 2010 Oct;76(1):129-34. doi: 10.1016/j.ejrad.2009.06.028. Epub 2009 Jul 19.
To evaluate the prevalence of nephrogenic systemic fibrosis (NSF) in a patient population being at highest risk for developing this disease and to evaluate possible risk factors.
The radiological records of 552 patients with ESRD being on hemodialysis (HD) or peritoneal dialysis (PD) were retrospectively reviewed to identify whether the patients underwent MR-examinations with or without intravenous administration of GBCA. In case of exposure to GBCA, the number of contrast injections, the benchmark and the cumulative doses of GBCA, and possible cofactors regarding pathogenesis of NSF were recorded. Diagnosis of NSF was confirmed either by deep skin biopsy or by review of medical and histopathological records. Data of NSF patients were compared with data of dialysis patients who did not develop NSF after MR-examinations.
146 dialysis patients underwent MRI without i.v.-administration of GBCA. No case of NSF was observed in this patient population. 195/552 patients proved to have a total number of 325 well-documented exposures to GBCA. Seven different types of GBCA were used during these MR-examinations. NSF prevalence rate was 1.6%. One patient died of NSF. Three different types of GBCA were involved in 6 NSF cases. 4/6 proved to be confounded cases. The cumulative dose of GBCA, history of thrombosis, recent surgery, and the combination of HD and PD proved to be significant cofactors for the development of NSF (p<.05). No significant difference regarding residual renal clearance (p=.898) and residual urine volume (p=.083) was found between NSF and non-NSF patients.
The prevalence of NSF proved to be much lower in this high risk patient group being exposed to GBCA compared to the literature. NSF was not observed in ESRD patients undergoing MRI without administration of GBCA. Our data support a positive association between cumulative dose of GBCA and development of NSF. No positive association was found between residual renal clearance and residual urine volume and NSF.
评估患有肾病且存在发展肾源性系统性纤维化（NSF）风险的患者群体中 NSF 的患病率，并评估可能的风险因素。
回顾性分析 552 名接受血液透析（HD）或腹膜透析（PD）治疗的终末期肾病（ESRD）患者的放射学记录，以确定患者是否进行了 MRI 检查，包括有无静脉内 GBCA 给药。如果接触了 GBCA，则记录造影剂注射次数、基准和累积 GBCA 剂量，以及与 NSF 发病机制相关的可能影响因素。NSF 的诊断通过深部皮肤活检或审查医疗和组织病理学记录来确认。将 NSF 患者的数据与未接受 MRI 检查后发生 NSF 的透析患者的数据进行比较。
146 名透析患者在未接受静脉内 GBCA 给药的情况下进行了 MRI 检查，该患者群体中未观察到 NSF 病例。552 名患者中有 195 名患者共进行了 325 次有明确记录的 GBCA 暴露检查。在这些 MRI 检查中使用了 7 种不同类型的 GBCA。NSF 的患病率为 1.6%。1 例患者死于 NSF。6 例 NSF 中有 3 例涉及 3 种不同类型的 GBCA，其中 4 例为混杂病例。GBCA 累积剂量、血栓形成史、近期手术以及 HD 和 PD 的联合使用被证明是 NSF 发展的显著相关因素（p<.05）。NSF 患者和非 NSF 患者的残余肾清除率（p=.898）和残余尿量（p=.083）无显著差异。
与文献相比，在接触 GBCA 的高风险患者群体中，NSF 的患病率明显较低。在未接受 GBCA 给药的 ESRD 患者中未观察到 NSF。我们的数据支持 GBCA 累积剂量与 NSF 发展之间存在正相关。残余肾清除率和残余尿量与 NSF 之间未发现正相关。
