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Ironjustic
Fri, Nov-02-07, 17:16
"Iron mobilization"

Brief Reviews

New Insights into Nephrogenic Systemic Fibrosis Sundararaman
Swaminathan and Sudhir V. Shah Division of Nephrology,
Department of Internal Medicine, University of Arkansas for
Medical Sciences; Central Arkansas Veterans Healthcare System,
Little Rock, Arkansas

Correspondence to: Dr. Sundararaman Swaminathan, Division of
Nephrology, University of Arkansas for Medical Sciences, 4301
W Markham Street #501, Little Rock, AR 72205. Phone:
501-686-5295; Fax: 501-686-7878; E-mail: sswaminathan@uams.edu

Nephrogenic systemic fibrosis is a new disorder reported
almost exclusively in patients who have renal insufficiency
and are exposed to contrast media formulated with gadolinium.
High morbidity and mortality are associated with this severely
disabling and painful condition. The acute phase begins upon
exposure to gadolinium contrast media, characterized by a
systemic inflammatory response involving iron mobilization,
and then as a progressive, chronic phase in which fibrosis
develops. Proposed is a unifying model of cumulative risk
factors in which the interplay of systemic inflammation and
stimulated hematopoietic environment associated with
hyperparathyroidism and erythropoietin may tie to a common
pathogenic mechanism of fibrogenesis. Because there are no
uniformly effective interventions to treat nephrogenic
systemic fibrosis other than successful renal transplantation,
prevention by avoiding gadolinium contrast media in patients
with chronic kidney disease is vital. On the basis of
suspected pathogenesis, it is also reasonable to limit
erythropoietin and iron therapy to dosages ensuring
recommended targets and adequately control
hyperparathyroidism. Herein is reviewed what is currently
known about this subject.

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