II. Epidemiology
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Incidence:
- Rare, overall Incidence
- Severe Renal Failure and exposure to gadalinium: 4%
III. Pathophysiology
- Triad of Gadolinium exposure, Renal disease, and Proinflammatory state
IV. Risk Factors
- Gadolinium Exposure
- Gadodiamide (Omniscan)
- Gadopentetate dimeglumine (Magnevist)
- Gadoversetamide (Optimark)
- Renal dysfunction (Stage 4-5)
- Severe renal dysfuntion (GFR<30 ml/min)
- Hemodialysis or Peritoneal Dialysis
- Acute Renal Failure
- Proinflammatory state
- Recent major surgery
- Thrombosis history
- Malignancy
- High dose Erythropoietin
V. Prevention
- Avoid gadolinium-based Contrast Material when GFR <30 ml/min or Hepatorenal-mediated Acute Renal Failure
VI. Course
- Onset within 2-3 months of gadolinium exposure (median 11 days)
VII. Symptoms
- Pruritic rash involving symmetric extremities and trunk
VIII. Signs
- Erythematous Plaques with induration and swelling symmetrically distributed on extremities and trunk
- Peau d'orange appearance
IX. Diagnosis
- Skin biopsy of lesion (include depth to subcutaneous fat or fascia)
- CD34 spindle-shaped fibrocytes with thickened Collagen bundles
X. Complications
- Debilitating joint contractures
- Multi-system fibrosis and resulting multi-system organ failure
- Respiratory Failure (due to diaphragmatic involvement)
XI. Prognosis
- Mortality: 31%