Nephrogenic systemic fibrosis.

Nephrogenic systemic fibrosis (NSF) is a relative new disease affecting predominantly patients with severely impaired kidney function. Strict adherence to a concordant clinical and pathological definition has allowed for careful separation of this entity from other fibrosing disorders, leading eventually to the realization that gadolinium based contrast agents were closely associated with its onset. Gadodiamide and similarly unstable Gd-CA should therefore not be used in patients with renal insufficiency. The clinical symptoms of NSF vary considerably from patient to patient. NSF should be suspected in renal failure patients presenting any possible NSF symptom appearing in the weeks after Gd-enhanced MRI. Suspected cases should have a skin biopsy taken from an affected region for the histological confirmation or rejection of the diagnosis. There are no established curative treatments to NSF patients. Prevention is the only alternative. Guidelines for the daily routine seem to be the right way. When NSF is identified the primary goal is reversal of underlying renal failure or renal transplantation. In addition, use of physical therapy and pain control is mandatory. One of the best news in late 2007 is the decreasing rate of newly detected NSF cases. In the case this development continues, NSF may become an historical disease in the near future.