Korean J Med.  2015 Mar;88(3):267-272. 10.3904/kjm.2015.88.3.267.

Prevention of Nephrogenic Systemic Fibrosis

• Lee DW

• KMID: 2082585
• DOI: http://doi.org/10.3904/kjm.2015.88.3.267

Abstract

Gadolinium is widely used as a contrast agent for magnetic resonance imaging (MRI). In patients with radiocontrast media-induced nephrotoxicity, MRI has generally been considered to be a safe substitute for computed tomography (CT). However, recent studies have described the potential emergence of gadolinium-related nephrogenic systemic fibrosis (NSF) in patients with advanced kidney disease. NSF is a fibrosing disorder seen only in patients with moderate to severe kidney failure; it is particularly common in patients on dialysis. Skin involvement occurs in all patients and is characterized by plaques, papules, nodules, thickening, and hardening of the skin overlying the extremities and trunk. Histopathologic examination of an incisional or punch biopsy of affected skin reveals marked expansion and fibrosis of the dermis with proliferation of CD34+ fibrocytes and long dendritic processes. There is no proven medical treatment for NSF other than recovery of renal function. Therefore, the currently recommended preventive measure for NSF in patients with advanced kidney failure is avoidance of gadolinium. Gadolinium-containing contrast agents, especially at high doses, should be used only if clearly necessary. Prompt commencement of hemodialysis may be necessary after gadolinium administration.

Keyword

Gadolinium; Kidney failure; Magnetic resonance imaging; Nephrogenic systemic fibrosis

MeSH Terms

Biopsy
Contrast Media
Dermis
Dialysis
Extremities
Fibrosis
Gadolinium
Humans
Kidney Diseases
Magnetic Resonance Imaging
Nephrogenic Fibrosing Dermopathy*
Renal Dialysis
Renal Insufficiency
Skin
Contrast Media
Gadolinium