title: The debate between gadolinium versus erythropoietin in a renal transplant patient with nephrogenic systemic fibrosis.
abstract: Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a debilitating skin condition that causes fibrotic changes in the setting of renal failure. Gadolinium-based contrast agents (GBCA), erythropoietin (EPO), and vascular intervention are the most widely known associated factors in the pathogenesis. A 53-year-old female with chronic renal insufficiency secondary to fibrillary glomerulonephritis (FGN) presented with generalized hardening of skin 1 week after her renal transplant. Due to her numerous medical and surgical health problems, she had received six imaging procedures with GBCA with the last being eight months prior to the onset of her skin symptoms. She had also historically been treated with high doses of EPO. Histopathologic examination was consistent with NSF. In susceptible renal failure patients who develop NSF after GBCA exposure, the onset of symptoms is usually within a 2-3 month time frame, which undermines but not eliminates the proposed role of GBCA in our patient. It can be proposed that despite having various risk factors, while being exposed to high doses of EPO, vascular trauma during renal transplant facilitated the onset of her symptoms.
authors.affiliation: Department of Dermatology, New York Medical College, NY, USA. panteahashemi@gmail.com
authors.forename: Pantea
authors.initials: P
authors.lastname: Hashemi
authors.forename: Bahram
authors.initials: B
authors.lastname: Sina
authors.forename: William
authors.initials: W
authors.lastname: Rietkerk
authors.forename: Bijan
authors.initials: B
authors.lastname: Safai
mesh_terms: D003287:Contrast Media / Q000009:adverse effects*; D004921:Erythropoietin / Q000009:adverse effects*; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D051436:Renal Insufficiency, Chronic / Q000601:surgery
chemical_list: D003287:Contrast Media; D004921:Erythropoietin; D005682:Gadolinium