Nephrogenic Systemic Fibrosis

Background

• Rare but serious scleroderma-like condition associated with gadolinium (MRI contrast) exposure in patients with renal impairment
• Risk of nephrogenic systemic fibrosis (NSF) with any renal impairment, acute or chronic, does not have to have ESRD

Clinical Features

• Develops days to years after gadolinium exposure
• Chronic, progressive
• Skin becomes tight, thick, shiny, and indurated skin, with fibrotic nodules and plaques and brawny hyperpigmentation
  • Painful, pruritic
  • Extremities most commonly affected, followed by trunk. Face rarely involved
• Flexion contractures when lesions overlie joints, limited range of motion
• Neuromuscular involvement can occur
• In most severe cases, fibrosis involves internal organs (heart, lungs, liver)

Management

• No specific management, supportive care

Disposition

• Discharge

See Also

• MRI contraindications