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A disease of contrast

MagazineApril 2011 (Vol. 22 Issue 1)A disease of contrast

Nephrogenic systemic fibrosis (NSF) is a new disease caused by a contrast agent (gadodiamide) used in magne-tic resonance imaging (MRI)

Nephrogenic systemic fibrosis (NSF) is a new disease caused by a contrast agent (gadodiamide) used in magne-tic resonance imaging (MRI). First identified in 1997 by Dr Thomas Grobner in Austria and first described in a report in 2000 (Lancet, 2000, 356: 1000-1), it was initially called 'nephrogenic fibrosing dermopathy' (NFD), but renamed in 2005 as 'nephro-genic systemic fibrosis' (NSF).

At the time, the cause(s) was only suspected, but was firmly established in 2006 by Dr Henrik Thomsen in Denmark. The contrast agent OmniscanTM, a gado-diamide, was found to release the toxic metal gadolinium during contrast-enhanced MRI. However, there are other brands of gadodiamides (Dotarem, Magnevist), and whether these also release gadolinium is not yet known, although warnings have now been issued concerning the risk of NSF.

NSF symptoms and treatment

Patients with NSF have swelling and tightening of the skin, usually on the extremities-arms, hands, legs and feet-but sometimes also on the trunk. The condition develops over a period of days or weeks. The swelling inhibits joint movement-flexion and extension-and often results in joint stiffness that prevents full extension. Severely affected patients may even be unable to walk. Complaints of muscle weakness are common. Radiography may reveal calcifications in soft tissues, and deep bone pain has been described in the hips and ribs.

Skin changes may start as red or dark patches, papules or plaques. Over time, the skin may feel 'woody' and resemble orange peel. Patients may experience burning, itching and/or sharp pain in areas of involvement.

The skin lesions on the limbs are often symmetrical. Hand and foot swelling with blister-like lesions may also occur, and some patients report yellow papules or plaques around or near the eyes. Also, there is a rapid new onset of fluctuating hypertension of unknown cause prior to the onset of the skin lesions.

Is there a cure for NSF ? So far, there has been no consistently successful treatment with conventional medicine. Improving kidney function (by any means) appears to slow or arrest NSF and, in a few cases, has allowed for gradual reversal of the condition over time. As NSF is a rare, relatively recent, diagnosis, the natural history of the disease is not yet well understood.

However, several patients with NSF have died as a result of complications with their kidney disease or subsequent to surgery.

What can we do about NSF?

OmniscanTM has been in use since 1993 and, since then, some 50 million MRI scans have been performed using Omniscan-and the number is growing every day. The procedure relies on adequate kidney and lymphatic functions to flush the contrast agent from the body. In 2007, the EU banned Omniscan for use in patients with "reduced renal function", while the US Food and Drug Administration (FDA) issued a warning against all gadodiamides and recommended their "use only if necessary".

However, many GPs know nothing of NSF so, when they encounter its symptoms, they don't know to question the patient about any MRI and contrast agent used. Hence, most cases go undetected, with its symptoms attributed to other conditions. Indeed, there could be thousands of NSF cases out there-but there are no official incident rates.

What is said of GPs also applies to CAM therapists and practitioners of Natural Medicine. However, while it may be difficult to get the message to GPs, I hope to spread the word among those who practise non-orthodox medicine.

It requires concerted diagnostic acumen to identify NSF patients-and it's difficult to establish an effective treatment. Although my own approach has succeeded in bringing about improvement in some patients (Gaier HC. Thorson's Encyclopaedic Dictionary of Homoeopathy. London: HarperCollins Publishers, 1991: 137; ISBN 0722518234), it cannot be viewed as a sure path to treatment and cure. I apply a method of systemic medicinal drainage, using a scientifically proven homeopathic treatment that promotes effective detoxification of the body by administering gadolinium 7CH in a water-ethanol mixture (Th'erapie, 1955; 10: 625-38; Th'erapie, 1958; 13: 46-55, 438-50).
Harald Gaier


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