The Clinical Manifestations and Efficacy of Different Treatments Used for Nephrogenic Systemic Fibrosis: A Systematic Review

Abstract

Aim Nephrogenic systemic fibrosis (NSF) is a rare disorder that occurs in association majorly with chronic kidney disease (CKD). The lack of collective quantitative data on its clinical manifestations and the different treatment options’ efficacy, call the need for our investigation. Methods A systematic review was conducted covering a timeline from inception up to July 2022 without any restrictions. Article screening and data extraction were performed independently on PubMed, Google Scholar, ScienceDirect, and Cochrane Library. The keywords that we used were CKD, NSF, Gadolinium enduced fibrosis, etc; shortlisted articles were assessed for risk of bias. Data were presented as frequencies and percentages, with a confidence interval of 95%. A chi-square test was also done to find significant relationships, with a p -value <0.05 considered significant. Results We had 83 patients in this review consisting of 44 (55.7%) females with a mean age of 51.4±14.6 years. Sixty-nine (83.1%) patients had chronic kidney disease predisposition to NSF. Previous exposure to gadolinium-based contrast dyes was seen in 66 (79.5%) patients). The most common symptom in patients was cutaneous lesions in 69 (83.1%) patients. The most used treatments were ultraviolet therapy, renal transplant, and extracorporeal photopheresis; in 13.3% of the patients each. Condition in most patients either improved (67.1%) or remained stable (11.8%). Chi-square testing found that the treatments offered were also seen to be significantly related to outcome (p=0.015). Conclusion The findings in this study provide a quantitative measurement of NSF’s presentations and treatment efficacies. This serves to make way for researchers to form comprehensive guidelines on the presentation-based treatment of NSF.

Pulsed Ultraviolet C as a Potential Treatment for COVID-19

“…Of note, although we propose UVC primarily as a prophylactic measure against the fibroproliferative conditions, it might also serve as a treatment of post COVID-19 pulmonary fibrosis. This assumption are positive results of UV treatment (UVA and UVB) of various forms of fibrosis, such as nephrogenic systemic fibrosis and scleroderma [33][34][35].…”

Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review

“…Currently, there is no curative treatment, but intensive physiotherapy may help maintain physical abilities and reverse some disabilities [ 54 , 55 ]. Proposed treatments include renal transplant, extracorporeal photopheresis, UV therapy, sodium thiosulfate, corticosteroids, imatinib mesylate therapies, dialysis, and immunosuppressants [ 56 , 57 ]. While HD may partially improve symptoms, renal transplantation has shown more significant improvements, including complete resolution of NSF in some cases [ 58 , 59 ].…”