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Nephrogenic systemic fibrosis
Nephrogenic systemic fibrosis (NSF) or Nephrogenic fibrosing dermopathy is a rare and serious syndrome that involves fibrosis of skin, joints, eyes, and internal organs. Its cause is not fully understood, but it seems to be associated with exposure to gadolinium (which is frequently used as a contrast substance for MRIs) in patients with severe kidney failure. It does not have a genetic basis.
Additional recommended knowledge
In NSF, patients develop large areas of hardened skin with fibrotic nodules and plaques. Flexion contractures with an accompanying limitation of range of motion can also occur. NSF resembles scleromyxedema at the histologic (microscopic) level; it shows a proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers, and deposits of mucin. 
Most patients with NSF have undergone hemodialysis for renal failure, some have never undergone dialysis and others have received only peritoneal dialysis. Many patients have taken immunosuppressive medications and have other diseases, such as hepatitis C. Four of the five FDA-approved gadolinium contrast agents have been principally implicated in NSF, including Omniscan, Multihance, Magnevist, and OptiMARK.
The first cases of NSF were identified in 1997, but NSF was first described as an independent disease entity in 2000. While skin involvement is on the foreground, the process may involve any organ and resembles diffuse scleroderma or systemic sclerosis.  In 2006, the link between NSF and gadolinium-containing contrast agents was made. As a result, gadolinium-containing contrast is now considered contraindicated in patients with an estimated glomerular filtration rate (a measure of renal function) under 60 and especially under 30.
It can be noted that this classification was released after another proposition would have left the safest category (ionic cyclical structure) with only one agent (Dotarem, not sold in North America). The intermediate category would have been both ionic linear structure and non-ionic cyclical structure. The third category most at risk was unchanged (linear non-ionic).
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Nephrogenic_systemic_fibrosis". A list of authors is available in Wikipedia.|