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Published on: July 3, 2013
Nephrogenic systemic fibrosis is associated with hypophosphataemia: a case-control study
Elana J Bernstein1, Tamara Isakova2, Mary E Sullivan2
1Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL, MGH Clinical Research Center, Massachusetts General Hospital, Boston, MA, Department of Neurology, Program for Neuropsychiatric Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, USA. ejb2153@columbia.edu.
Patients with stage 5 chronic kidney disease (CKD) and nephrogenic systemic fibrosis (NSF) exhibit lower phosphorus levels. This suggests phosphorus metabolism differences may contribute to NSF development beyond gadolinium-based contrast agent exposure.
Area of Science:
- Nephrology
- Fibrotic Diseases
- Mineral Metabolism
Background:
- Nephrogenic systemic fibrosis (NSF) is a severe fibrotic condition linked to gadolinium-based contrast agents (GBCAs) in chronic kidney disease (CKD) patients.
- Altered calcium and phosphorus metabolism are observed in NSF, but additional contributing factors require investigation.
Purpose of the Study:
- To explore potential factors beyond GBCA exposure in NSF pathogenesis.
- To compare calcium, phosphorus, fibroblast growth factor 23 (FGF23), and 25-hydroxy-vitamin D levels in stage 5 CKD patients with and without NSF.
Main Methods:
- Measured serum levels of phosphorus, calcium, FGF23, and 25-hydroxy-vitamin D.
- Compared these levels between 10 stage 5 CKD patients with biopsy-proven NSF and 19 stage 5 CKD patients without NSF.
- Utilized Fisher's exact test and Kruskal-Wallis test for statistical analysis.
Main Results:
- Patients with NSF demonstrated significantly lower phosphorus levels compared to controls (P = 0.01).
- No significant differences were found in calcium, 25-hydroxy-vitamin D, intact parathyroid hormone, or FGF23 levels between the NSF and control groups.
Conclusions:
- Phosphorus metabolism may differ between stage 5 CKD patients with and without NSF.
- These findings suggest a potential role for phosphorus dysregulation in the development of NSF.
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