Nephrogenic Systemic Fibrosis Associated With Gadoversetamide Exposure: Treatment With Sodium Thiosulfate

Nephrogenic systemic fibrosis (NSF) is a debilitating fibrosing disorder of patients with kidney disease that is associated with gadolinium-based contrast exposure. Most cases are linked to gadodiamide. Gadoversetamide, an agent with chelate characteristics similar to gadodiamide, has rarely been described to cause NSF. With the exception of normalization of kidney function, there are no consistently effective therapies for patients with NSF. We describe 3 cases of NSF in patients with end-stage renal disease after gadolinium-based contrast exposure. Two patients received gadoversetamide and the third received gadodiamide. All 3 patients were treated early in their disease course with intravenous sodium thiosulfate and responded with improved skin changes and joint mobility.