More Gadolinium Deposition in Affected Than Nonaffected Skin in Nephrogenic Systemic Fibrosis

Nephrogenic systemic fibrosis was first linked to gadolinium-containing contrast agents a few years ago (JW Dermatol Mar 2 2007). The exact mechanism of pathogenesis is unknown. It has been proposed that free gadolinium is released from its chelated form via a process known as transmetallation, and because free gadolinium is cleared through the kidneys, patients with impaired renal function are at risk for toxicity. Deposition of gadolinium in tissue is believed to result in migration of circulating CD34⁺ and procollagen I–positive cells into the affected tissue; this process subsequently activates transforming growth factor β, which then leads to deposition of mucin, elastin, and collagen.

These investigators assessed concentrations of gado…