Wednesday, April 07, 2010

Nephrogenic systemic fibrosis

---is the latest scleroderma mimic. It can cause disabling skin contractures, internal organ involvement and sometimes be fatal. A recent review in Journal of Hospital Medicine offers helpful advice.

Here's the skinny:

The risk of NSF varies with the brand of gadolinium based contrast used. Gadoteridol (Prohance) carries the lowest risk. Gadodiamide (Omniscan) is a high risk product. The others are intermediate in risk.

Avoid contrast in patients with GFR below 30 (be careful how you estimate GFR!), those with ESRD and those with AKI.

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