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Korean J Med > Volume 88(3); 2015 > Article
The Korean Journal of Medicine 2015;88(3): 267-272.
신장기원 전신섬유증의 예방
이동원
부산대학교 의학전문대학원 내과학교실 신장내과
Prevention of Nephrogenic Systemic Fibrosis
Dong Won Lee
Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
Corresponding Author: Dong Won Lee ,Tel: +82-55-360-2359, Fax: +82-55-360-1606, Email: dongwonlee@pusan.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Gadolinium is widely used as a contrast agent for magnetic resonance imaging (MRI). In patients with radiocontrast media-induced nephrotoxicity, MRI has generally been considered to be a safe substitute for computed tomography (CT). However, recent studies have described the potential emergence of gadolinium-related nephrogenic systemic fibrosis (NSF) in patients with advanced kidney disease. NSF is a fibrosing disorder seen only in patients with moderate to severe kidney failure; it is particularly common in patients on dialysis. Skin involvement occurs in all patients and is characterized by plaques, papules, nodules, thickening, and hardening of the skin overlying the extremities and trunk. Histopathologic examination of an incisional or punch biopsy of affected skin reveals marked expansion and fibrosis of the dermis with proliferation of CD34+ fibrocytes and long dendritic processes. There is no proven medical treatment for NSF other than recovery of renal function. Therefore, the currently recommended preventive measure for NSF in patients with advanced kidney failure is avoidance of gadolinium. Gadolinium-containing contrast agents, especially at high doses, should be used only if clearly necessary. Prompt commencement of hemodialysis may be necessary after gadolinium administration.
Keywords: Gadolinium; Kidney failure; Magnetic resonance imaging; Nephrogenic systemic fibrosis
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