Nephrogenic systemic fibrosis--implications for nephrologists.
Nephrogenic systemic fibrosis (NSF) is a debilitating disorder seen in-patient with advanced chronic kidney disease (CKD). Recent evidence suggests a link between NSF and the administration of gadolinium-based contrast agents (Gd-CA). In addition, other risk factors have also been suggested to facilitate the development of NSF in this population after Gd-CA. These include metabolic acidosis, high-dose erythropoietin therapy, and the altered mineral metabolism of CKD. While it is possible that these factors may increase the risk of NSF after Gd-CA exposure, they may also simply reflect conditions that increase the risk of getting exposed to Gd-CA, particularly at high doses. Furthermore, given the risk of NSF in CKD, physicians must weigh the risks of NSF versus the risk of contrast-induced nephropathy (CIN) with iodinated agents in this population. In this review, we will provide a nephrologist's perspective on these issues and the nephrologist's role in the prevention of NSF.
Saab
Georges
G
Department of Internal Medicine, Division of Nephrology, University of Missouri, Columbia School of Medicine, MA436 Health Sciences Center, Columbia, MO 65212, USA. saabg@health.missouri.edu
Abu-Alfa
Ali
A
D003287:Contrast Media / Q000009:adverse effects*; D005355:Fibrosis / Q000139:chemically induced / Q000517:prevention & control; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D012307:Risk Factors; D012871:Skin Diseases / Q000139:chemically induced* / Q000517:prevention & control
D003287:Contrast Media; D005682:Gadolinium