NYMC Faculty Publications

The Debate Between Gadolinium Versus Erythropoietin in a Renal Transplant Patient With Nephrogenic Systemic Fibrosis

Author Type(s)

Faculty

DOI

10.5301/jn.5000159

Journal Title

Journal of Nephrology

First Page

48

Last Page

54

Document Type

Article

Publication Date

1-1-2013

Keywords

Contrast Media, Erythropoietin, Female, Gadolinium, Humans, Kidney Transplantation, Magnetic Resonance Imaging, Middle Aged, Nephrogenic Fibrosing Dermopathy, Renal Insufficiency, Chronic

Disciplines

Medicine and Health Sciences | Nephrology

Abstract

Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a debilitating skin condition that causes fibrotic changes in the setting of renal failure. Gadolinium-based contrast agents (GBCA), erythropoietin (EPO), and vascular intervention are the most widely known associated factors in the pathogenesis. A 53-year-old female with chronic renal insufficiency secondary to fibrillary glomerulonephritis (FGN) presented with generalized hardening of skin 1 week after her renal transplant. Due to her numerous medical and surgical health problems, she had received six imaging procedures with GBCA with the last being eight months prior to the onset of her skin symptoms. She had also historically been treated with high doses of EPO. Histopathologic examination was consistent with NSF. In susceptible renal failure patients who develop NSF after GBCA exposure, the onset of symptoms is usually within a 2-3 month time frame, which undermines but not eliminates the proposed role of GBCA in our patient. It can be proposed that despite having various risk factors, while being exposed to high doses of EPO, vascular trauma during renal transplant facilitated the onset of her symptoms.

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