Nephrogenic systemic fibrosis: pathogenesis, diagnosis, and therapy.
Nephrogenic systemic fibrosis (NSF) is a newly recognized disorder occurring exclusively in patients with renal failure. Exposure to gadolinium-based magnetic resonance (MR) contrast media has been associated with subsequent development of NSF. Nephrogenic systemic fibrosis is characterized by skin induration preferentially affecting the extremities. In addition, involvement of internal organs occurs, which leads ultimately to death. Skin biopsy is important for confirmation of the diagnosis. The main therapeutic goal is restoration of renal function. To reduce the risk of NSF, renal function must be determined before exposure to gadolinium-containing MR contrast agents. Gadolinium-based MR contrast media should be avoided in the presence of advanced renal failure with estimated glomerular filtration rate below 30 ml/min/1.73 m2, unless the diagnostic information is essential and not available with noncontrast magnetic resonance imaging techniques. The recommended dose of contrast agent should not be exceeded. In addition, a sufficient period of time for elimination of the contrast agent from the body should be allowed before readministration of the contrast agent.
Kribben
Andreas
A
Department of Nephrology, University Duisburg-Essen, Essen, Germany. andreas.kribben@unidue.de
Witzke
Oliver
O
Hillen
Uwe
U
Barkhausen
Jörg
J
Daul
Anton E
AE
Erbel
Raimund
R
D003287:Contrast Media / Q000009:adverse effects; D005682:Gadolinium / Q000009:adverse effects; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D054989:Nephrogenic Fibrosing Dermopathy / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D012307:Risk Factors
D003287:Contrast Media; D005682:Gadolinium