Ten-year experience with nephrogenic systemic fibrosis: case-control analysis of risk factors.
OBJECTIVE
To analyze all cases of nephrogenic systemic fibrosis (NSF) at our institution and to compare them with controls.


METHODS
After the institutional review board approval, 13 biopsy-proven NSF cases were identified. Ten cases had complete records and were compared in a case-control format with 10 age- and sex-matched, dialysis-dependent controls. Analyzed risk factors included single and cumulative gadolinium dose, medication and transplant history, and serum electrolytes at the time of gadolinium exposure.


RESULTS
There were 1.9% of dialysis-dependent, gadolinium-exposed patients who developed NSF. There was no difference in gadolinium dose, transplant history, or serum electrolytes. Seven of 10 cases and 3 of 10 controls were treated with erythropoietin (P = 0.13). At the time of NSF diagnosis, 7 of 10 cases were on immunosuppressive therapy. Two of 7 cases developed NSF only after immunosuppressive therapy was initiated. Two of 10 controls were on immunosuppressive therapy (P = 0.06).


CONCLUSIONS
All cases of NSF occurred in dialysis-dependent, gadolinium-exposed patients. Associations between immunosuppressive and erythropoietin therapies and NSF need further investigation.
Bahrami
Simin
S
Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095-7437, USA. sbahrami@mednet.ucla.edu
Raman
Steven S
SS
Sauk
Steven
S
Salehmoghaddam
Saleh
S
Villablanca
Juan Pablo
JP
Finn
J Paul
JP
Lu
David S K
DS
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D003287:Contrast Media / Q000009:adverse effects*; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors
D003287:Contrast Media; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D005682:Gadolinium