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Nephrogenic systemic fibrosis: pathogenesis, diagnosis, and therapy
Andreas Kribben1, Oliver Witzke, Uwe Hillen
1Department of Nephrology, University Duisburg-Essen, Essen, Germany. andreas.kribben@unidue.de
Journal of the American College of Cardiology
|May 2, 2009
Summary
Nephrogenic systemic fibrosis (NSF) is a severe condition linked to gadolinium contrast agents in patients with kidney failure. Careful screening of renal function before MRI contrast administration is crucial to prevent NSF.
Area of Science:
- Nephrology
- Radiology
- Dermatology
Background:
- Nephrogenic systemic fibrosis (NSF) is a debilitating disorder exclusively affecting patients with renal failure.
- Gadolinium-based contrast media used in magnetic resonance (MR) imaging are strongly associated with NSF development.
- NSF manifests as skin induration, primarily on extremities, and can progress to fatal internal organ involvement.
Purpose of the Study:
- To highlight the association between gadolinium contrast agents and NSF in patients with renal impairment.
- To emphasize diagnostic confirmation methods and therapeutic goals for NSF.
- To provide guidelines for minimizing NSF risk in patients undergoing MR imaging.
Main Methods:
- Review of clinical presentation and diagnostic criteria for NSF.
- Analysis of the link between gadolinium exposure and NSF incidence.
- Assessment of risk mitigation strategies, including renal function assessment and contrast agent administration protocols.
Main Results:
- Skin biopsy is essential for confirming NSF diagnosis.
- Restoration of renal function is the primary therapeutic objective.
- Pre-imaging assessment of renal function is critical to prevent NSF.
Conclusions:
- Gadolinium-based MR contrast media should be avoided in patients with advanced renal failure (eGFR < 30 ml/min/1.73 m2) unless essential and noncontrast alternatives are unavailable.
- Adherence to recommended contrast agent doses and appropriate intervals between administrations is vital.
- Proactive management of renal function is key to reducing the incidence of NSF.
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