Nephrogenic systemic fibrosis: risk factors and incidence estimation

Radiology. 2007 Apr;243(1):148-57. doi: 10.1148/radiol.2431062144. Epub 2007 Jan 31.


Purpose: To retrospectively review data in 13 patients with biopsy-confirmed nephrogenic systemic fibrosis (NSF), assess the associated risk factors, and report the incidence of NSF at the authors' institution.

Materials and methods: This HIPAA-compliant study had institutional review board approval; informed consent was waived. Statistical analysis was performed for all available clinical and laboratory data in patients with biopsy-confirmed NSF. The data from the patients with NSF were compared with data from a control population of patients with renal insufficiency but who did not develop NSF.

Results: There were eight male and five female patients, aged 17-69 years, with a diagnosis of NSF. Within 6 months of diagnosis, all 13 patients had been exposed to gadodiamide and one had been exposed to gadobenate dimeglumine in addition to gadodiamide. At the time of contrast material-enhanced magnetic resonance (MR) imaging, all 13 patients had renal insufficiency (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)) and were hospitalized for a proinflammatory event (major surgery, infection, or vascular event). The group with NSF had significantly decreased eGFR (P = .01), more proinflammatory events (P < .001), and more contrast-enhanced MR examinations per patient (P = .002) than did the control group.

Conclusion: A combination of factors, including altered kidney function, inflammatory burden, and exposure to gadolinium-based contrast agents may all play a role in development of NSF. Alternative imaging should be considered in patients with these factors. If use of a gadolinium-based agent is clinically indicated, the referring physician and patient should be informed of the potential risk of developing NSF.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Contrast Media / adverse effects*
  • Female
  • Fibrosis
  • Gadolinium DTPA / adverse effects*
  • Glomerular Filtration Rate
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging / adverse effects*
  • Male
  • Meglumine / adverse effects
  • Meglumine / analogs & derivatives
  • Middle Aged
  • Organometallic Compounds / adverse effects
  • Renal Insufficiency / complications*
  • Retrospective Studies
  • Risk Factors
  • Skin / pathology*
  • Skin Diseases / chemically induced*


  • Contrast Media
  • Organometallic Compounds
  • gadobenic acid
  • Meglumine
  • gadodiamide
  • Gadolinium DTPA