Blog | Thursday, November 18, 2010

A nephrologic mystery


I'm at Renal Week (the annual meeting of the American Society of Nephrology) in beautiful 60 degree (!) Denver this week, so expect lots of reports on kidneys and their troubles.

A session this morning covered nephrogenic systemic fibrosis. Since even the FDA and I have already written about this, you're probably aware that this painful and damaging condition is caused by using gadolinium for contrast studies in patients with impaired renal function (so you should avoid the studies whenever possible in these patients and use the lowest risk agents). But did you know about the mystery of NSF's origins?

The first gadolinium agents (and the ones most associated with NSF) were approved in 1989 and 1993, yet the first cases of NSF didn't appear until 1997. Researchers have even gone back and searched tissue samples from the time period to see if the disease was around, but not diagnosed and reported. They found...(cue spooky music)...nothing. So if gadolinium causes NSF, why was there gadolinium but no NSF in the early and mid '90s? No one knows, but they suspect that there must be some as-yet-unidentified co-factor at work, session speaker and nephrologist Joel Topf, MD, said. Pretty mysterious, isn't it?