Nephrogenic systemic fibrosis in liver disease: A systematic review

Abstract

Nephrogenic systemic fibrosis (NSF) may develop in patients with liver disease, a fact highlighted by Food and Drug Administration (FDA) announcements cautioning against the use of gadolinium‐based contrast agents (GBCAs) in select liver disease patients. The purpose of this systematic literature review is to characterize the risk of NSF in patients with liver disease. All published articles on NSF from September 2000 through August 2008, were identified via PubMed searches and examination of articles' reference lists. Two reviewers independently read each article and identified unique patients with biopsy‐proven or suspected NSF. Data on demographics, liver status, renal status, and GBCA exposure were collected. A total of 324 articles were reviewed, with 108 articles containing case descriptions of 335 unique NSF patients. After excluding the 95/335 (28%) patients in whom the presence or absence of liver disease was uncertain, liver disease was confirmed present in 41/239 (17%) patients. Renal insufficiency could be assessed in 35 of the liver disease patients; severe renal insufficiency, defined as a glomerular filtration rate (GFR) or estimated GFR (eGFR) <30 mL/min/1.73 m2 or dialysis requirement, was present in 34/35 (97%) patients. The lone patient who developed NSF with mild/moderate renal insufficiency was atypical and received a total gadodiamide load of 0.76 mmol/kg over a 10‐week period periliver transplantation. The published medical literature demonstrates that patients with liver disease who develop NSF also have severe renal insufficiency, suggesting that liver disease does not confer a risk for NSF beyond that of the underlying renal insufficiency. J. Magn. Reson. Imaging 2009;30:1313–1322. © 2009 Wiley‐Liss, Inc.

Nephrogenic Systemic Fibrosis and Diabetes Mellitus

“…1,2 Eflornithine, the only prescription topical agent approved in the United States for female facial hirsutism, has only a 32% success rate and has not been evaluated in men. 1 Therefore, additional topical treatments effective in preventing hair growth are needed. The antiviral agent cidofovir has been reported to induce local alopecia when applied topically.…”

“…Many risk factors have been implicated, including liver disease, 1 erythropoietin, 2 proinflammatory and hypercoagulable conditions, dialysis, and gadolinium exposure. 3 Diabetes mellitus (DM) and renal failure are both associated with fibrosing disorders.…”

Gadolinium and nephrogenic systemic fibrosis: an update

“…A review of 335 NSF cases in 2009 confirmed liver disease in 41 patients but failed to demonstrate any statistically significant increased risk due to the liver disease alone. Renal impairment was severe in all cases bar one, in which AKI was described [24]. The conclusion drawn in the European and American guidelines is that patients most at risk of NSF are those with CKD stage 4 or 5, including those needing dialysis and those with reduced renal function who have or are awaiting liver transplantation.…”

“…Erythropoietin use was seen in up to 80 %, although this may simply have reflected erythropoietin resistance relating to chronic inflammation [23]. Other risk factors, including liver disease [24], immunosuppression [25], hyperphosphatemia [26], and acidosis [2], were reported but not consistently reproduced. At this stage, it appeared that NSF involved a process of sensitizing events (renal disease and some proinflammatory condition) and an unidentified trigger (e.g., allergen deposition) [27].…”

Special issue: Nephrogenic systemic fibrosis

“…We present current guidelines for injection of GBCA as used in the United States, Canada, Europe (20) and Japan (21). Furthermore, risk factors for NSF are reviewed (22), and NSF is discussed in the context of renovascular (23) and liver disease (24). The issue of relative risk of NSF versus CIN is addressed in the excellent review by Martin and other experts on this topic (25).…”