NSF: Real or Hype?

In 1996 a new disease was diagnosed. Ten years later it turned out to be an adverse reaction to some gadolinium-based contrast agents. Within 2 years it was clear that (1) it was only seen in patients with reduced renal function, particularly CKD 5 or on dialysis; (2) it was mainly in patients who had had gadodiamide; (3) the severity of the adverse reaction varies from a plaque to universal fibrosis; (4) the incidence varies from 3% (retrospective data) to 18% (prospective data); and (5) the higher the dose the higher the risk, but it is also seen after a single dose. Thanks to clear guidelines recommending that high-risk agents are not used in patients with poor renal function or on dialysis, the adverse reaction is no longer seen. Nephrogenic systemic fibroses was a reality for almost 20 years.