Nephrogenic Systemic Fibrosis

  • Patients with stage 4-5 CKD (GFR < 30 mL/min) are at risk of developing NSF if gadolinium (Gd3+)- based contrast agents (Gd-CA) are used for MR imaging
  • Risk may be as high as 18% in some some subgroups
  • Gd3+ attaches to endogenous anions (phosphate, hydroxide, carbonate, citrate), forming insoluble salts that deposit in tissues and initiate fibrosis
NSF is characterized by:
  •  Discolored skin plaques
    • Can be itchy and painful
  • Contractures of joints
    • Potential for complete loss of range of motion
  • Potentially widespread fibrosis
    • Liver, lungs, muscles, and heart
  • NSF may be more likely in patients with recent inflammatory event
    • Surgical intervention, infection, or thrombotic event



Nephrogenic systemic fibrosis most often occurs as the result of which of the following?

A. Chemotherapy with alkylating agent
B. RBC transfusion
C. Platelet transfusion
D. Peritoneal dialysis
E. MRI with gadolinium contrast