Nephrogenic systemic fibrosis - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2023-03-22T17:23:16Z

Differential Diagnosis

← Older revision		Revision as of 17:23, 22 March 2023
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	*[[Porphyria]]		*[[Porphyria]]
	*Eosinophilic fasciitis		*Eosinophilic fasciitis

			{{Contrast complications DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2016-09-24T06:28:05Z

Background

← Older revision		Revision as of 06:28, 24 September 2016
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	==Background==		==Background==
	*~~Gadolinium exposure~~ (MRI ~~with~~ contrast) to patients with renal ~~insufficiency~~ (HD, PD, transplant)		*Rare but serious scleroderma-like condition associated with gadolinium (MRI contrast) exposure in patients with renal impairment (e.g. hemodialysis, peritoneal dialysis, transplant)
			**Risk with any renal impairment, acute or chronic, does not have to have ESRD
	*Poorly understood pathogenesis		*Poorly understood pathogenesis
	*Chronic, progressive condition with rare cases of resolution in cases of return of renal function		*Chronic, progressive condition with rare cases of resolution in cases of return of renal function
	*Rare but serious scleroderma-like condition associated with gadolinium (MRI contrast) exposure in patients with renal impairment
	*Risk of nephrogenic systemic fibrosis (NSF) with any renal impairment, acute or chronic, does not have to have ESRD

	===Associated Illnesses===		===Associated Illnesses===

Rossdonaldson1: /* Clinical Features */

2016-09-24T06:26:46Z

Clinical Features

← Older revision		Revision as of 06:26, 24 September 2016
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	*History of HD, PD, renal transplant		*History of HD, PD, renal transplant
	*Gadolinium exposure, with timeline of symptom onset variable		*Gadolinium exposure, with timeline of symptom onset variable
	*~~Tightened, thickened, shiny skin~~		**Develops days to years after gadolinium exposure
	*Peau d'orange appearance
	*Hand stiffening
	*Flexion contractures, severe mobility issues
	*Extremities more commonly affected than trunk
	*Face is almost never involved


	*Develops days to years after gadolinium exposure
	*Chronic, progressive		*Chronic, progressive
	*Skin becomes tight, thick, shiny, and indurated skin, with fibrotic nodules and plaques and brawny hyperpigmentation		*Skin becomes tight, thick, shiny, and indurated skin, with fibrotic nodules and plaques and brawny hyperpigmentation
	**Painful, pruritic		**Painful, pruritic
			**Peau d'orange appearance
	**Extremities most commonly affected, followed by trunk. Face rarely involved		**Extremities most commonly affected, followed by trunk. Face rarely involved
	*Flexion contractures when lesions overlie joints, limited range of motion		*Flexion contractures when lesions overlie joints, limited range of motion
			**Hand stiffening
			**Extremities more commonly affected than trunk
	*Neuromuscular involvement can occur		*Neuromuscular involvement can occur
	*In most severe cases, fibrosis involves internal organs (heart, lungs, liver)		*In most severe cases, fibrosis involves internal organs (heart, lungs, liver)

Rossdonaldson1: /* Disposition */

2016-09-24T06:24:05Z

Disposition

← Older revision		Revision as of 06:24, 24 September 2016
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	==Disposition==		==Disposition==
	*Discharge (~~Does~~ not inherently require inpatient care)		*Discharge (does not inherently require inpatient care)
	*Follow up with dermatologist for deep skin bx		*Follow up with dermatologist for deep skin biopsy
	*Follow up with nephrologist for renal disease management		*Follow up with nephrologist for renal disease management

Rossdonaldson1: /* Workup */

2016-09-24T06:23:05Z

Workup

← Older revision		Revision as of 06:23, 24 September 2016
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	*Eosinophilic fasciitis		*Eosinophilic fasciitis

	==~~Workup~~==		==Evaluation==
	*No particular lab or imaging diagnostics		*No particular lab or imaging diagnostics
	*Deep skin biopsy, including dermis, subQ fat, fascia		*Deep skin biopsy, including dermis, subQ fat, fascia

Rossdonaldson1 at 06:22, 24 September 2016

2016-09-24T06:22:13Z

← Older revision		Revision as of 06:22, 24 September 2016
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	*Rare but serious scleroderma-like condition associated with gadolinium (MRI contrast) exposure in patients with renal impairment		*Rare but serious scleroderma-like condition associated with gadolinium (MRI contrast) exposure in patients with renal impairment
	*Risk of nephrogenic systemic fibrosis (NSF) with any renal impairment, acute or chronic, does not have to have ESRD		*Risk of nephrogenic systemic fibrosis (NSF) with any renal impairment, acute or chronic, does not have to have ESRD

			===Associated Illnesses===
			*[[SLE]]
			*[[Hepatitis]]
			*[[Eosinophilia]]

	==Clinical Features==		==Clinical Features==
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	*Extremities more commonly affected than trunk		*Extremities more commonly affected than trunk
	*Face is almost never involved		*Face is almost never involved
	*Associations:
	**[[SLE]]
	**[[Hepatitis]]
	**Eosinophilia

Rossdonaldson1 at 06:21, 24 September 2016

2016-09-24T06:21:35Z

@@ Line 3: / Line 3: @@
 *Poorly understood pathogenesis
 *Chronic, progressive condition with rare cases of resolution in cases of return of renal function
 ==Clinical Features==
 *History of HD, PD, renal transplant
 *Gadolinium exposure, with timeline of symptom onset variable
@@ Line 17: / Line 20: @@
 **[[Hepatitis]]
 **Eosinophilia
 ==Differential Diagnosis==
@@ Line 31: / Line 44: @@
 ==Management==
 *Treatments anecdotal and of minimal benefit
 **Extracorporeal photopheresis (ECP)
@@ Line 38: / Line 53: @@
 ==Disposition==
-*Dermatologist for deep skin bx
+*Discharge (Does not inherently require inpatient care)
-*Nephrologist for renal disease management
+*Follow up with dermatologist for deep skin bx
-*Does not inherently require inpatient care
+*Follow up with nephrologist for renal disease management
 ==See Also==
 *[[MRI contraindications]]
 ==External Links==
 ==References==
 <references/>
-[[Category:Renal]] [[Category:Radiology]]
+[[Category:Radiology]]

Rossdonaldson1 at 06:19, 24 September 2016

2016-09-24T06:19:03Z

← Older revision		Revision as of 06:19, 24 September 2016
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	[[Category:Radiology]]		[[Category:Radiology]]

			[[File:NephrogenicSystemicFibrosis.png\|thumb]]
			==Background==
			*Rare but serious scleroderma-like condition associated with gadolinium (MRI contrast) exposure in patients with renal impairment
			*Risk of nephrogenic systemic fibrosis (NSF) with any renal impairment, acute or chronic, does not have to have ESRD

			==Clinical Features==
			*Develops days to years after gadolinium exposure
			*Chronic, progressive
			*Skin becomes tight, thick, shiny, and indurated skin, with fibrotic nodules and plaques and brawny hyperpigmentation
			**Painful, pruritic
			**Extremities most commonly affected, followed by trunk. Face rarely involved
			*Flexion contractures when lesions overlie joints, limited range of motion
			*Neuromuscular involvement can occur
			*In most severe cases, fibrosis involves internal organs (heart, lungs, liver)

			==Differential Diagnosis==

			==Evaluation==

			==Management==
			*No specific management, supportive care

			==Disposition==
			*Discharge

			==See Also==
			*[[MRI contraindications]]
			==External Links==

			==References==
			<references/>

			[[Category:Renal]] [[Category:Radiology]]

Rossdonaldson1: Text replacement - "Hx " to "History "

2016-07-15T05:35:47Z

Text replacement - "Hx " to "History "

← Older revision		Revision as of 05:35, 15 July 2016
Line 5:		Line 5:

	==Clinical Features==		==Clinical Features==
	*Hx of HD, PD, renal transplant		*History of HD, PD, renal transplant
	*Gadolinium exposure, with timeline of symptom onset variable		*Gadolinium exposure, with timeline of symptom onset variable
	*Tightened, thickened, shiny skin		*Tightened, thickened, shiny skin

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-07T20:05:54Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 20:05, 7 July 2016
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	*Deep skin biopsy, including dermis, subQ fat, fascia		*Deep skin biopsy, including dermis, subQ fat, fascia

	==~~Treatment~~==		==Management==
	*Treatments anecdotal and of minimal benefit		*Treatments anecdotal and of minimal benefit
	**Extracorporeal photopheresis (ECP)		**Extracorporeal photopheresis (ECP)