Nephrogenic systemic fibrosis
NSF also known as nephrogenic fibrosing dermopathy is characterised by "firm, erythematous, and indurated plaques of the skin associated with subcutaneous oedema" 1. Eventually flexure contractures develop, with restriction to movement, pain and pruritis. Although the skin is primarily involved, many solid organs can also be involved, eventually leading to death. (lungs, heart, diaphragm, liver, and kidneys).
"Recent reports have strongly correlated the development of NSF with exposure to gadolinium-containing MRI contrast agents" 2 in patients with moderate to end stage renal impairment. Additional positive risk modifiers (increase risk) include:
- concurrent infection / inflammatory condition.
- concurrent infarcted / ischaemic tissue (e.g. peripheral arterial thromboembolism).
- recent surgery / trauma.
Recommendations
- Avoid gadolinium containing contrast agents in patients who
- eGFR < 30 mL/min/1.73 m2
- eGFR < 60 mL/min/1.73 m2 (probably) 1
"When contrast-enhanced MR imaging is requested for a patient with renal insufficiency who is hospitalized due to major surgery, major infection, or a vascular thrombotic event, alternative imaging is indicated to avoid use of gadolinium-based contrast agents; this decision should be made after consultation with the referring service and the patient " 1.
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