What Nephrologists Need to Know About Gadolinium

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Author(s)

Jeffrey G Penfield, MD

Staff Physician, Section of Nephrology, Veterans Affairs North Texas Health Care System, Dallas, Texas; Assistant Professor of Medicine, Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas

Disclosures

Disclosure: Jeffrey G. Penfield, MD, has disclosed no relevant financial relationships.

Robert F Reilly, Jr, MD

Professor of Medicine; Fredric L. Coe Professor of Nephrolithiasis Research; Chief, Division of Nephrology, VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Disclosures

Disclosure: Robert F. Reilly, Jr., MD, has disclosed no relevant financial relationships.

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Treatment of Nephrogenic Systemic Fibrosis

Treatment of NSF is often unsuccessful. Most therapies have only been tested informally and the results published as case reports. NSF can improve with recovery of renal function after, for example, successful kidney transplantation or resolution of AKI. Published reports of treatments are often of limited value as they do not comment on the course of renal dysfunction. Disease regression must be interpreted in light of GFR; improvement of NSF in the setting of a rising GFR might result from reversal of the renal lesion and not from therapy for NSF per se. Ultraviolet A1 treatment was reported to be successful in one patient, but reversal of AKI might have been the true cause of improvement.^[72] Plasmapheresis was reportedly effective in another patient, but, again, improvement of renal function could have been the actual cause of recovery.^[67] Extracorporeal photopheresis was beneficial in three patients whose kidney function did not improve.^[57] Sodium thiosulfate was reported to improve symptoms in a patient with ESRD on chronic hemodialysis.^[73] The mobility of one peritoneal dialysis patient partially improved after the first, but not subsequent, courses of intravenous immunoglobulin.^[74] Physical therapy is recommended to prevent and treat joint contractures.