Nephrogenic systemic fibrosis: Risk factors and incidence estimation
Nephrogenic systemic fibrosis: Risk factors and incidence estimation
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DOI：
10.1148/radiol.2431062144
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发表时间：
2007-04-01
期刊：
影响因子：
19.7
通讯作者：
Djamali, Arjang
中科院分区：
文献类型：
--
作者：
Sadowski, Elizabeth A.;Bennett, Lindsey K.;Djamali, Arjang
用途：回顾性分析13例经活检证实的肾源性系统性纤维化（NSF）患者的资料，评估相关的危险因素，并报告作者所在机构NSF的发病率。材料和方法：本符合HIPAA的研究已获得机构审查委员会的批准;知情同意书被免除。对活检证实的NSF患者的所有可用临床和实验室数据进行统计分析。从NSF患者的数据进行了比较，从肾功能不全的患者，但谁没有开发NSF.Results的对照人群的数据：有8名男性和5名女性患者，年龄17-69岁，诊断为NSF。在诊断后6个月内，所有13例患者均暴露于钆双胺，1例患者除钆双胺外还暴露于钆贝葡胺。在造影剂增强磁共振（MR）成像时，所有13例患者均患有肾功能不全（估计肾小球滤过率[eGFR] < 60 mL/min/1.73 m2），并因促炎事件（大手术，感染或血管事件）住院。与对照组相比，NSF组的eGFR显著降低（P = .01），促炎事件（P < .001）更多，每位患者的对比增强MR检查（P = .002）更多。结论：多种因素的组合，包括肾功能改变、炎症负荷和暴露于钆基造影剂，可能都在NSF的发展中发挥作用。在有这些因素的患者中应考虑替代成像。如果临床上有使用钆基药物的指征，应告知转诊医生和患者发生NSF的潜在风险。
Purpose: To retrospectively review data in 13 patients with biopsy-confirmed nephrogenic systemic fibrosis (NSF), assess the associated risk factors, and report the incidence of NSF at the authors' institution.Materials and Methods: This HIPAA-compliant study had institutional review board approval; informed consent was waived. Statistical analysis was performed for all available clinical and laboratory data in patients with biopsy-confirmed NSF. The data from the patients with NSF were compared with data from a control population of patients with renal insufficiency but who did not develop NSF.Results: There were eight male and five female patients, aged 17-69 years, with a diagnosis of NSF. Within 6 months of diagnosis, all 13 patients had been exposed to gadodiamide and one had been exposed to gadobenate dimeglumine in addition to gadodiamide. At the time of contrast material enhanced magnetic resonance (MR) imaging, all 13 patients had renal insufficiency ( estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)) and were hospitalized for a proinflammatory event ( major surgery, infection, or vascular event). The group with NSF had significantly decreased eGFR (P = .01), more proinflammatory events ( P < .001), and more contrast- enhanced MR examinations per patient ( P = .002) than did the control group.Conclusion: A combination of factors, including altered kidney function, inflammatory burden, and exposure to gadolinium-based contrast agents may all play a role in development of NSF. Alternative imaging should be considered in patients with these factors. If use of a gadolinium-based agent is clinically indicated, the referring physician and patient should be informed of the potential risk of developing NSF.