What Causes Nephrogenic Systemic Fibrosis?

Other institutions, such as mine, have adopted similar policies for all gadolinium-containing contrast agents. However, because NSF has also developed in several patients with stage 4 chronic kidney disease (glomerular filtration rate 15 to 29 mL/min/1.73 m2), similar caution should be observed in all patients with creatinine clearance less than 30 mL/min/1.73 m2 and possibly those with lesser degrees of renal dysfunction. Only prospective epidemiologic studies will define the level of renal function above which it is safe to administer gadolinium-containing contrast agents without the risk of developing NSF.

Future studies should be directed toward understanding the molecular mechanism by which fibrosis occurs following gadolinium exposure in patients with underlying chronic kidney disease and targeting that mechanism with specific therapies that will prevent development of and reverse fibrosis.

Dr. Kay is director of the Rheumatology Clinical Research Unit and associate clinical professor of medicine at the Massachusetts General Hospital and Harvard Medical School in Boston.

References

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