title: Nephrogenic systemic fibrosis: a report of 29 cases.
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis and its relation to renal failure and the administration of gadolinium-based contrast material at an academic medical center.
  
  
  METHODS
  A dermatopathology database was searched to identify patients in whom nephrogenic systemic fibrosis was diagnosed. The medical records of these patients were reviewed. Renal function concurrent with any administration of gadolinium-based contrast material was assessed, as was patient outcome. A database of patients undergoing long-term dialysis was reviewed separately to determine how many had received gadolinium and the frequency of nephrogenic systemic fibrosis among these patients.
  
  
  RESULTS
  Twenty-nine patients were found to have had nephrogenic systemic fibrosis between November 15, 1999, and December 31, 2006. It was known that gadolinium-based contrast material had been administered to 25 of these patients before diagnosis. All 29 patients had compromised renal function (27 had chronic renal failure, and two had acute renal failure). Determination of the temporal relation between gadolinium-based contrast administration and symptom onset often was difficult. Only eight patients had severe morbidity. Nephrogenic systemic fibrosis developed in 12 (2.9%) of 414 patients undergoing long-term dialysis who received gadolinium-based contrast material.
  
  
  CONCLUSIONS
  We confirm the strong association between nephrogenic systemic fibrosis and gadolinium-based contrast administration. Although the use of high doses of gadolinium and the occurrence of chronic renal failure have been implicated in other reports, several of our patients received standard doses of gadolinium, and two had transient acute renal failure before diagnosis. Most patients had mild or moderate symptoms. Nephrogenic systemic fibrosis developed in 2.9% of patients undergoing long-term dialysis who received gadolinium-based contrast material but in none of the long-term dialysis patients who did not receive gadolinium-based contrast material.
authors.affiliation: Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr., Room-B1D502G, Ann Arbor, MI 48109-0030, USA.
authors.forename: Wael M
authors.initials: WM
authors.lastname: Shabana
authors.forename: Richard H
authors.initials: RH
authors.lastname: Cohan
authors.forename: James H
authors.initials: JH
authors.lastname: Ellis
authors.forename: Hero K
authors.initials: HK
authors.lastname: Hussain
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Francis
authors.forename: Lyndon D
authors.initials: LD
authors.lastname: Su
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Mukherji
authors.forename: Richard D
authors.initials: RD
authors.lastname: Swartz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D016208:Databases, Factual; D005355:Fibrosis; D005682:Gadolinium / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D012871:Skin Diseases / Q000453:epidemiology*
chemical_list: D003287:Contrast Media; D005682:Gadolinium