title: Nephrogenic systemic fibrosis: risk factors and incidence estimation.
abstract: OBJECTIVE
  To retrospectively review data in 13 patients with biopsy-confirmed nephrogenic systemic fibrosis (NSF), assess the associated risk factors, and report the incidence of NSF at the authors' institution.
  
  
  METHODS
  This HIPAA-compliant study had institutional review board approval; informed consent was waived. Statistical analysis was performed for all available clinical and laboratory data in patients with biopsy-confirmed NSF. The data from the patients with NSF were compared with data from a control population of patients with renal insufficiency but who did not develop NSF.
  
  
  RESULTS
  There were eight male and five female patients, aged 17-69 years, with a diagnosis of NSF. Within 6 months of diagnosis, all 13 patients had been exposed to gadodiamide and one had been exposed to gadobenate dimeglumine in addition to gadodiamide. At the time of contrast material-enhanced magnetic resonance (MR) imaging, all 13 patients had renal insufficiency (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)) and were hospitalized for a proinflammatory event (major surgery, infection, or vascular event). The group with NSF had significantly decreased eGFR (P = .01), more proinflammatory events (P < .001), and more contrast-enhanced MR examinations per patient (P = .002) than did the control group.
  
  
  CONCLUSIONS
  A combination of factors, including altered kidney function, inflammatory burden, and exposure to gadolinium-based contrast agents may all play a role in development of NSF. Alternative imaging should be considered in patients with these factors. If use of a gadolinium-based agent is clinically indicated, the referring physician and patient should be informed of the potential risk of developing NSF.
authors.affiliation: Department of Radiology, University of Wisconsin, Madison, WI 53792-3252, USA. esadowski@uwhealth.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sadowski
authors.forename: Lindsey K
authors.initials: LK
authors.lastname: Bennett
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Wentland
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Garrett
authors.forename: Robert W
authors.initials: RW
authors.lastname: Garrett
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA / Q000009:adverse effects*; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000009:adverse effects*; D008297:Male; D008536:Meglumine / Q000009:adverse effects / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000139:chemically induced*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; C064925:gadodiamide; D019786:Gadolinium DTPA