Nephrogenic Systemic Fibrosis, Gadolinium, and Iron Mobilization

To the Editor: Nephrogenic systemic fibrosis is a newly described systemic disorder that occurs in patients with renal insufficiency. 1 , 2 The functional consequences of nephrogenic systemic fibrosis are often devastating and may be fatal. Since nephrogenic systemic fibrosis develops after exposure to gadolinium-containing magnetic resonance contrast agents in some patients, 3 the Food and Drug Administration recommended avoiding such agents in patients with renal insufficiency. The mechanism by which nephrogenic systemic fibrosis develops after gadolinium exposure remains unknown. Gadolinium is administered as a chelate, since free gadolinium is toxic. Metals such as iron are capable of inducing the dissociation of gadolinium . . .