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Nephrogenic systemic fibrosis--implications for nephrologists
1Department 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
Abstract:
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.
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