Nephrogenic systemic fibrosis: A frivolous entity

Abstract

Gadolinium-based contrast agents (GBCAs) used in magnetic resonance imaging are vital in providing enhanced quality images, essential for diagnosis and treatment. Nephrogenic systemic fibrosis (NSF) with GBCAs has been a deterrent for the physician and has led to avoidance of these agents in patients with impaired kidney function. NSF is a progressive debilitating multisystem condition described classically in patients with renal insufficiency exposed to gadolinium contrast media. It is characterized by an induration and hardening of the skin. NSF is described to first involve the extremities and can imperceptibly involve internal organs. Lack of therapeutic interventions to treat NSF makes it more challenging and warrants deep insight into the pathogenesis, risk factors and treatment strategies.

Keywords: Chronic kidney disease; Dialysis; End stage kidney disease; Gadolinium-based contrast agents; Magnetic resonance imaging; Nephrogenic systemic fibrosis.

Figure 1

Postulated pathophysiology of nephrogenic systemic fibrosis. PTH: Parathyroid Hormone; ECM: Extracellular matrix; hPMBC: Human peripheral mononuclear blood cells; MCP-2: Monocyte chemoattractant protein-2; MMP: Metalloproteinases; TIMP: Tissue inhibitor of metalloproteinase.