Diabetic kidney disease (nephropathy) is the leading cause of end-stage renal failure in the United States and other Western nations. Kidney patients may undergo a type of MRI called magnetic resonance angiography (MRA) to assess their blood vessels.

The chemical compound gadolinium may be injected into a patient's vein to enhance the contrast of images in MRAs. The U.S. Food and Drug Administration (FDA) recently cautioned that a rare skin condition called nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy (NSF/NFD) was reported in 25 European kidney patients who underwent an MRA with high-dose gadolinium contrast. The FDA says it has approved five gadolinium-containing contrast media for standard MRIs but none for MRAs, which often involve a much higher dosage of the chemical.

The cause of NSF/NFD is unknown, but it has been found in people with kidney failure and acidosis, a buildup of waste products. It is marked by tightened skin, decreased joint mobility, joint pain and muscle weakness. It can scar and impair the function of internal organs, sometimes fatally. A skin biopsy is used for diagnosis.

Researchers at the University of Colorado and elsewhere examined 13 blocks of tissue samples from seven patients with NSF/NFD who had received gadolinium as a contrast medium. Using an electron microscope, the scientists found gadolinium in four of the samples. No gadolinium was found in control tissue samples.

The researchers concluded that gadolinium had a long history of safe use in MRIs but advised caution in patients with chronic kidney failure. "While clearly more research needs to be done, we are encouraged by our findings and hope that it provides an important first step in understanding the cause of this elusive disease. Until more data becomes available, we urge patients with end-stage kidney disease and their health care providers to be aware of this potentially fatal association between gadolinium and NSF/NDF and make every effort to avoid any unnecessary, excessive dosage of this contrast agent," lead researcher Dr. Whitney A. High stated in a news release.

The FDA earlier this year recommended that patients with advanced kidney failure receive gadolinium contrast agents only if clearly necessary and suggested beginning dialysis in such patients who receive a gadolinium MRA. It continues to investigate the matter.

The study was published this month in the Journal of the American Academy of Dermatology.

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