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3059996 
Journal Article 
Abstract 
Pulmonary findings at autopsy in gadolinium-related nephrogenic systemic fibrosis 
Abraham, JL; Narendra, S; Davis, R 
2010 
Yes 
American Journal of Respiratory and Critical Care Medicine
ISSN: 1073-449X
EISSN: 1535-4970 
181 
A1758 
English 
WOS:000208771000758 
is part of a larger document 3452678 Proceedings of the American Thoracic Society 2010 International Conference, May 14-19, 2010, New Orleans
RATIONALE. Nephrogenic systemic fibrosis (NSF) is a skin and frequently systemic fibrosing disorder seen in patients with impaired renal function, causally related to the release of Gadolinium (Gd) from its chelated form in MRI contrast agents. Clinical reports have mentioned pulmonary fibrosis as one of the outcomes in NSF, but the pulmonary pathology of NSF has not been extensively evaluated. We review the pulmonary findings in 11 consecutive skin-biopsy-proven NSF autopsy cases sent to our lab from multiple laboratories for review and multi-organ Gd analysis.

METHODS. Autopsy slides containing lung parenchymal tissue were reviewed by two pathologists for consensus grading of location, pattern and extent of calcification, fibrosis, inflammation, congestion, and other findings. Analysis of tissues using scanning electron microscopy and energy-dispersive x-ray spectroscopy (SEM/EDS) were done by a third pathologist.

RESULTS. Patients ranged from age 24-80 (median 51) yr; 5 Female, 5 Male, 1 unknown. The number of available lung slides per case varied from 2 -12 (median 5). The main finding common to all cases was calcification involving blood vessels and/or alveolar and airway interstitium. Minimal interstitial fibrosis was seen in some but not all of the cases. No consistent pattern of fibrosis, inflammation, or other histopathology was seen. Evidence of vascular congestion and/or pulmonary edema was noted in 8/11 cases. Individual cases showed variable terminal processes such as diffuse alveolar damage, pneumonia, and thromboembolism. Gd was detected in 4 of 5 lung tisues examined to date using SEM/EDS. As in all NSF cases analyzed to date, the Gd deposits in pulmonary tissues are in the form of insoluble Gd-phosphate-calcium compounds.

CONCLUSION. This small series of autopsies of NSF patients indicates that the only consistent histopathologic finding in the lungs may be metastatic calcification in large and small blood vessels, large and small airways and alveolar walls. No findings to support a diagnosis of any single pattern of interstitial fibrosis is evident. It is probable that pulmonary radiologic findings and physiologic findings seen in NSF may be related to tissue calcification, congestive heart failure and other changes common in advanced renal failure. Whether NSF promotes more rapid and severe progression of these findings than in renal failure patients without NSF is in need of further investigation. 
American Thoracic Society 2010 International Conference 
New Orleans, LA 
May 14-19, 2010