Tag: nephrogenic fibrosing dermopathy

Posted on

Noon conference St John Macomb: Renal Adventures in Imaging

Yesterday I gave one of my favorite lectures, Renal Adventures in Imaging.
It is a lecture on three issues in nephrology that are not normally put together in a single lecture:
  1. Phosphate nephropathy
  2. Nephrogenic fibrosing dermopathy (I’ll never get used to calling it nephrogenic systemic fibrosis because, despite what the literature states, all five patients I have seen had purely dermatologic manifestations)
  3. Contrast nephropathy
I like the lecture because it is not a typical nephrology lecture. 
I gave the lecture Seder-style and had crammed for the last three days getting the booklet ready. It’s the longest booklet by one sheet (32 pages rather than my standard 28). It turned out pretty good, though the acetylcysteine section needs to be built up and I need to comb through it for typos.
Posted on

Patient information: Nephrogenic Fibrosing Dermopathy

Are MRIs safe for patients with kidney disease?

Sometimes. In 2000 a new skin disease was discovered that caused patients to develop thick skin around their joints, especially the knees. The thickened skin prevented people from bending their legs so they can’t walk. The disease was initially only found in patients on dialysis.The condition was named nephrogenic fibrosing dermopathy or NFD for short.

For a long time doctor’s had no idea what caused NFD. Then in 2006 some doctors in Europe noticed that only patients who received gadolinium during an MRI developed NFD. Other physicians verified this association and now it is generally accepted, though not proven, that gadolinium is at least part of the cause of NFD.

Gadolinium is used as contrast for patients receiving an MRI when doctors want a better view of the blood vessels. It is always used in a related imaging technique called an MRA. The FDA has identified people at risk of developing NFD. The list includes people with:
1. Acute renal failure
2. CKD stages 4 or 5
3. Cirrhosis induced kidney disease (called hepatorenal sndrome)
4. End-stage renal disease on dialysis

There is no proven strategy to prevent NFD except to avoid exposure to this agent. New contrast agents are being developed that do not have gadolinium. If your medical condition absolutely requires a gadolinium MRi then your doctor may schedule special dialysis sessions to remove the toxin right after MRI.

If you are on dialysis or have any of the other risk factors you should make sure your doctor knows about NFD and you should coordinate the MRI with your nephrologist.

There is no risk of NFD if you do not receive contrast with your MRI.

Posted on

Renal Adventures in Imaging


One of my favorite lectures. I’m supposed to give an hour lecture on contrast nephropathy but I find that the residents have excellent knowledge and instincts on this topic so I expand it in two other areas they are less well versed:

  1. Oral sodium phosphorous and nephrocalcinosis
  2. Nephrogenic fibrosing dermopathy

iPhone version
Booklet for printing

Posted on

Two Ell

This month I’m attending on the renal ward at Saint John Hospital and Medical Center. I have a huge team: one fellow, one second year resident, three interns (2 categorical and one ER resident) and two medical students. I have been having a blast teaching them.

I am going to track all of the teaching I do this month here.

So far this is the formal (as opposed to bedside) teaching we have done:

Monday June 2: Introduction to Two-Ell
Tuesday June 3: Nephrotic Syndrome
Wednesday June 4: Dialysis basics and Anti-hypertensive agents saves lives
Thursday June 5: Renal Adventures in Imaging (the nephrologic implications of Gadolinium and NFD, phosphate nephropathy as a complication of colonoscopy prep, and contrast nephropathy)

Adventures in Renal Imaging

More to come.