Nephrogenic Systemic Fibrosis (NSF)

Vascular surgery patients with arterial problems generally require angiograms to evaluate the patency of the vascular lumen. There is always a concern about doing an angiogram ( CT angio or conventional angio) in those patients with decreased eGFR. Some times MRangiogram with gadolinium is recommended in. those patients. But that can result in nephrogenic systemic fibrosis (NSF).

Nephrogenic systemic fibrosis (NSF) incidence was found to be found to be 4.3 cases per thousand patient-years. When gadolinium is used in a patient there is 2.4% risk of nephrogenic systemic fibrosis. NSF is also known as nephrogenic fibrosing dermopathy. This was first described in 2006 in the Journal of American Society of nephrology by Marckmann P et al describing a case series of 13 patients. New contrast agents are introduced with the hope that they have a lesser risk of NSF. Gadobenate dimeglumine is one such newer agent. Clinically NSF looks like scleroderma and eosinophilic fasciitis but histologically it looks like scleromyxedema. Biopsy shows proliferation of dermal fibroblasts, dendritic cells, thickened collagen bundles,   increases elastic fibers and mucin deposition. Toll-Like Receptors (TLR) four and seven seems to play an important role in the development of NSF. 

Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations (Joseph Lunyera 2020).