Possibly enhanced Gd excretion in dialysate, but no major clinical benefit of 3-5 months of treatment with sodium thiosulfate in late stages of nephrogenic systemic fibrosis.
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Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)?
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Renal toxicity of iodinated radiocontrast media (contrastinduced nephropathy; CIN) is a major cause of acute renal failure in hospitalised patients. Magnetic resonance imaging (MRI) is applied as an alternative technique but the use of gadolinium (Gd) containing contrast media carries the risk of nephrogenic systemic fibrosis (NSF), a potentially lethal disorder that occurs especially in patients with renal failure. In this article we give an update of the literature on toxicity of radiocontrast media and on preventive measures. Risk of nephrotoxicity of iodinated contrast media can be reduced by identification of high-risk patients. In these patients pre- and post-hydration with isotonic saline should be applied. When there is insufficient time to prehydrate, a short infusion protocol with sodium bicarbonate is preferable. There is a lack of evidence to support the use of oral or intravenous N-acetylcysteine or iso-osmolar contrast media. In order to prevent NSF , linear gadolinium chelates should not be used in patients with an estimated glomerular filtration rate (eGFR) of less than 30 ml/min. In patients with eGFR between 10 and 30 ml/min the small chance of NSF with cyclic Gd-containing chelates must be balanced against the high risk of developing CIN, and the morbidity and mortality associated with the start of dialysis. In patients without residual renal function, the small chance of developing NSF after macrocyclic Gd-enhanced MRI imaging may tip the balance to the use of iodine containing contrast media. (+info)
Nephrogenic fibrosing dermopathy.
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An adult female patient on hemodialysis for chronic renal failure presented with large, brownish, and indurated plaques with bound-down skin on both lower limbs and abdomen along with difficulty in movement of the legs. Histopathological features revealed thick collagen bundles admixed with mucin and intercalating spindle-like cells characteristic of nephrogenic fibrosing dermopathy (NFD). Immunohistochemical study showed prominent CD68 positivity and weak CD34 positivity suggesting that the plaques were more than 20-weeks old. NFD in patients with chronic renal failure of unknown cause is a poor prognostic indicator. Early detection before the development of contracture and prompt treatment of NFD and underlying renal failure may reverse this disabling condition. (+info)
Nephrogenic systemic fibrosis: incidence, associations, and effect of risk factor assessment--report of 33 cases.
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