2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2007060645v1 18/10/2636    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Swaminathan, S. Articles by Shah, S. V. Search for Related Content PubMed PubMed Citation Articles by Swaminathan, S. Articles by Shah, S. V.

New Insights into Nephrogenic Systemic Fibrosis

Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences; Central Arkansas Veterans Healthcare System, Little Rock, Arkansas

Correspondence to: Dr. Sundararaman Swaminathan, Division of Nephrology, University of Arkansas for Medical Sciences, 4301 W Markham Street #501, Little Rock, AR 72205. Phone: 501-686-5295; Fax: 501-686-7878; E-mail: sswaminathan{at}uams.edu

Nephrogenic systemic fibrosis is a new disorder reported almost exclusively in patients who have renal insufficiency and are exposed to contrast media formulated with gadolinium. High morbidity and mortality are associated with this severely disabling and painful condition. The acute phase begins upon exposure to gadolinium contrast media, characterized by a systemic inflammatory response involving iron mobilization, and then as a progressive, chronic phase in which fibrosis develops. Proposed is a unifying model of cumulative risk factors in which the interplay of systemic inflammation and stimulated hematopoietic environment associated with hyperparathyroidism and erythropoietin may tie to a common pathogenic mechanism of fibrogenesis. Because there are no uniformly effective interventions to treat nephrogenic systemic fibrosis other than successful renal transplantation, prevention by avoiding gadolinium contrast media in patients with chronic kidney disease is vital. On the basis of suspected pathogenesis, it is also reasonable to limit erythropoietin and iron therapy to dosages ensuring recommended targets and adequately control hyperparathyroidism. Herein is reviewed what is currently known about this subject.

This article has been cited by other articles:

				A. Tomasian, N. Salamon, D. G. Lohan, M. Jalili, J. P. Villablanca, and J. P. Finn Supraaortic Arteries: Contrast Material Dose Reduction at 3.0-T High-Spatial-Resolution MR Angiography--Feasibility Study Radiology, December 1, 2008; 249(3): 980 - 990. [Abstract] [Full Text] [PDF]

				J. A. Schroeder, C. Weingart, B. Coras, I. Hausser, S. Reinhold, M. Mack, V. Seybold, T. Vogt, B. Banas, F. Hofstaedter, et al. Ultrastructural Evidence of Dermal Gadolinium Deposits in a Patient with Nephrogenic Systemic Fibrosis and End-Stage Renal Disease Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 968 - 975. [Abstract] [Full Text] [PDF]

				C C Geddes and G M Baxter Renal impairment Imaging, March 1, 2008; 20(1): 1 - 19. [Abstract] [Full Text] [PDF]

				J. Kay, H. Bazari, L. L. Avery, and A. F. Koreishi Case 6-2008 -- A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin N. Engl. J. Med., February 21, 2008; 358(8): 827 - 838. [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673