title: Nephrogenic systemic fibrosis: review of 370 biopsy-confirmed cases.
abstract: Discovery of an association between gadolinium-based contrast agents (GBCAs) and nephrogenic systemic fibrosis (NSF) has led to less use of GBCA-enhanced magnetic resonance imaging in dialysis patients and patients with severe renal failure at risk of NSF, and the virtual elimination of new cases of NSF. But shifting patients with renal failure to alternative imaging methods may subject patients to other risks (e.g., ionizing radiation or iodinated contrast). This review paper examines 370 NSF cases reported in 98 articles to analyze NSF risk factors. Eliminating multiple risk factors by limiting GBCA dose to a maximum of 0.1 mmol/kg, dialyzing patients undergoing dialysis quickly following GBCA administration, delaying GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in patients with renal failure especially when there are proinflammatory conditions may substantially reduce the risk of NSF.
authors.affiliation: Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Zhitong
authors.initials: Z
authors.lastname: Zou
authors.forename: Hong Lei
authors.initials: HL
authors.lastname: Zhang
authors.forename: Giles H
authors.initials: GH
authors.lastname: Roditi
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.forename: Walter
authors.initials: W
authors.lastname: Kucharczyk
authors.forename: Martin R
authors.initials: MR
authors.lastname: Prince
mesh_terms: D001706:Biopsy; D003287:Contrast Media / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005682:Gadolinium / Q000009:adverse effects*; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D054989:Nephrogenic Fibrosing Dermopathy / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000517:prevention & control; D018579:Patient Selection; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D012867:Skin / Q000473:pathology*
chemical_list: D003287:Contrast Media; D005682:Gadolinium