The NSF Conundrum

Nephrogenic systemic fibrosis (NSF) is a rare, progressive, and sometimes fatal disorder found in patients with reduced kidney function. NSF is characterized by skin thickening, painful joint contractures, and fibrosis of multiple organs. There is an increasing recognition of NSF over the past decade and one of the first papers to describe NSF was a paper by Cowper et al in 2000.[1] In 2006, Marckmann et al and Grobner reported the association of NSF with gadolinium-based contrast agents (GBCAs).[2] [3] In 2006 and 2007, the US Food and Drug Administration (FDA) released an advisory and asked magnetic resonance (MR) contrast manufacturers to include a box warning on risk of NSF. By 2011, the American College of Radiology (ACR) and Yale International NSF registry had tracked 500 and 360 cases of NSF, respectively. The reported incidence of NSF has been steadily decreasing over the last decade.[4]