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Current Clinical Practice
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Korean J Med. 2015;88(3):267-272. Published online March 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.3.267
- 신장기원 전신섬유증의 예방
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이동원
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부산대학교 의학전문대학원 내과학교실 신장내과
- Prevention of Nephrogenic Systemic Fibrosis
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Dong Won Lee
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Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Corresponding author: Dong Won Lee ,Tel: +82-55-360-2359, Fax: +82-55-360-1606, Email: dongwonlee@pusan.ac.kr
- 신장기원 전신섬유증은 신기능이 저하된 환자에서 가돌리늄 조영제에 노출된 후 발생하는 전신 질환으로 가돌리늄에 노출된 병력과 특징적인 피부조직소견으로 진단이 가능하다. 현재까지는 입증된 치료법이 없기 때문에 전신섬유증이 발생할 수 있는 고위험군에서는 사용을 자제해야 하며 불가피하게 사용하는 경우에는 발생 빈도가 적었던 조영제를 저용량으로 사용하고 위험성을 평가하여 조기에 반복적으로 혈액투석을 시행하는 것이 도움이 될 수 있다.
߽ɾ :가돌리늄; 신부전; 자기공명영상; 신장기원 전신섬유증
- Abstract
- Gadolinium is widely used as a contrast agent for magnetic resonance imaging (MRI). In patients with radiocontrast media-induced nephrotoxicity, MRI has generally been considered to be a safe substitute for computed tomography (CT). However, recent studies have described the potential emergence of gadolinium-related nephrogenic systemic fibrosis (NSF) in patients with advanced kidney disease. NSF is a fibrosing disorder seen only in patients with moderate to severe kidney failure; it is particularly common in patients on dialysis. Skin involvement occurs in all patients and is characterized by plaques, papules, nodules, thickening, and hardening of the skin overlying the extremities and trunk. Histopathologic examination of an incisional or punch biopsy of affected skin reveals marked expansion and fibrosis of the dermis with proliferation of CD34+ fibrocytes and long dendritic processes. There is no proven medical treatment for NSF other than recovery of renal function. Therefore, the currently recommended preventive measure for NSF in patients with advanced kidney failure is avoidance of gadolinium. Gadolinium-containing contrast agents, especially at high doses, should be used only if clearly necessary. Prompt commencement of hemodialysis may be necessary after gadolinium administration.
Keywords :Gadolinium, Kidney failure, Magnetic resonance imaging, Nephrogenic systemic fibrosis
