<i>Editorials</i>: Nephrogenic Systemic Fibrosis: An Emerging Threat Among Renal Patients

DeHoratius, Danielle M.; Cowper, Shawn E.

doi:10.1111/j.1525-139x.2006.00152.x

Cited by 49 publications

(26 citation statements)

References 21 publications

(50 reference statements)

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“…Unlike contrast nephropathy, for which a return to normal renal function occurs in most patients, NSF commonly has a continuous or progressive course. Spontaneous resolution of NSF has not been described in any of the reported series (1,4,6,7). Contrast nephropathy from iodinated dye can be associated with an in-hospital mortality of up to 14.9% (20).…”

Section: Discussionmentioning

confidence: 98%

“…N ephrogenic systemic fibrosis (NSF) is a systemic disorder that is characterized by thickening and tightening of the skin and subcutaneous tissues (1). First observed in 1997, NSF was originally known as nephrogenic fibrosing dermopathy because of its classic presentation of symmetric, brawny, or erythematous indurated cutaneous plaques that develop in the setting of renal insufficiency (2,3).…”

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confidence: 99%

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Nephrogenic Systemic Fibrosis

Deo¹,

Fogel²,

Cowper³

2007

Clinical Journal of the American Society of Nephrology

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Nephrogenic systemic fibrosis (NSF) is a devastating complication of severe renal failure. Recent reports suggest that exposure to gadolinium-containing contrast agents (GCCA) is associated with the occurrence of NSF. The population of patients with ESRD in and around Bridgeport, CT, was studied during an 18-mo period. The incidence of NSF was 4.3 cases per 1000 patient-years. Each radiologic study using gadolinium presented a 2.4% risk for NSF. The association between gadolinium exposure and NSF was highly significant (P < 0.001). It is concluded that GCCA exposure is a major risk factor for NSF in the ESRD population. Because of the significant morbidity and mortality with NSF, it is believed that gadolinium exposure should be avoided in patients with ESRD. In the event that exposure cannot be avoided, careful consideration of the potential consequences, including a thorough discussion of the risks and benefits of GCCA, is advised.Clin J Am Soc Nephrol 2: 264 -267, 2007264 -267, . doi: 10.2215 N ephrogenic systemic fibrosis (NSF) is a systemic disorder that is characterized by thickening and tightening of the skin and subcutaneous tissues (1). First observed in 1997, NSF was originally known as nephrogenic fibrosing dermopathy because of its classic presentation of symmetric, brawny, or erythematous indurated cutaneous plaques that develop in the setting of renal insufficiency (2,3). Recognition that this syndrome can include fibrosis of skeletal muscle, lung, liver, testes, or myocardium with possible fatal outcomes led to the adoption of the more recent nomenclature: Nephrogenic systemic fibrosis (4,5).The cause of NSF remains speculative. Hypercoagulation syndromes, anti-phospholipid antibodies, deep vein thrombosis, metabolic acidosis, erythropoietin administration, and surgical or vascular interventions all have been implicated as possible contributing factors (6 -9). Several recent reports described the development of NSF after gadolinium exposure (9 -11). To follow up on these reports, we reviewed the use of gadolinium in our long-term dialysis population during an 18-mo period and analyzed its relationship to the development of NSF. Materials and MethodsWe retrospectively analyzed data from a population of patients who had ESRD and were living in the nine urban and suburban communities that surround Bridgeport, CT. The study population consisted of patients who had ESRD and were treated at one of three hemodialysis facilities or one peritoneal dialysis facility on July 1, 2006. These four programs were the only dialysis facilities in this geographic area, thus providing a population based study.Within this population, three cases of NSF were diagnosed in the 18-mo period that ended on July 1, 2006. Patients were identified on clinical grounds with confirmatory skin biopsies. The relationship between gadolinium exposure and NSF was documented, and details of the cases were recorded. The remaining patients who had ESRD and did not develop NSF served as the control group.We manually reviewed data from al...

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Nephrogenic Systemic Fibrosis

Deo¹,

Fogel²,

Cowper³

2007

Clinical Journal of the American Society of Nephrology

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235

152

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“…Mucin may be present (29,55,61,105), but is not required for the diagnosis (59). The abundant, thin, and spindle-shaped cells often express CD34 and type I (immature) procollagen (22,24,59).…”

Section: Histology and Immunohistologymentioning

confidence: 99%

Pathophysiology of gadolinium-associated systemic fibrosis

Wagner

Drel

Gorin

2016

American Journal of Physiology-Renal Physiology

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“…Since then, the number of reports of NSF has increased with more than 250 reports of NSF filed with regulatory authorities worldwide as of August 2007 [3]. Although the exact etiology of NSF is currently unknown, it is most likely multifactorial and, to date has only been reported in patients with severe renal insufficiency [4], many of whom were on hemodialysis or peritoneal dialysis [5]. Recent case reports and data from animal experiments suggest an association between NSF and exposure to gadolinium (Gd)-based contrast agents (GBCAs) [6][7][8], although NSF without prior Gd exposure has also been reported [9,10].…”

Section: Introductionmentioning

confidence: 99%