A unique case of nephrogenic systemic fibrosis from gadolinium exposure in a patient with normal eGFR

A 57-year-old woman presented with swelling and thickening of the skin of the lower extremities. Three months prior to presentation, patient had MRI with gadolinium as part of an evaluation for suspected pancreatic malignancy. Creatinine levels at the time of gadolinium exposure were 0.9–1.2 mg/dL,...

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Bibliographic Details
Published in:	BMJ case reports Vol. 2017; p. bcr-2017-221016
Main Authors:	Lohani, Sadichhya, Golenbiewski, Jon, Swami, Abhishek, Halalau, Alexandra
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 11-10-2017 BMJ Publishing Group
Series:	Case Report
Subjects:	African Americans Black Case reports Cell growth Clinical medicine Contrast Media - adverse effects Family medical history Female Gadolinium - adverse effects Glomerular Filtration Rate Humans Immunoglobulins Kidney diseases Magnetic Resonance Imaging Malnutrition Middle Aged Nephrogenic Fibrosing Dermopathy - chemically induced Nephrogenic Fibrosing Dermopathy - diagnosis Nephrogenic Fibrosing Dermopathy - therapy Pancreatic cancer Patients Physical Therapy Modalities Referral and Consultation Reminder of Important Clinical Lesson Scleroderma Skin Thyroid gland Treatment Outcome Urine USA/Canada renal system contraindications and precautions dermatology
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Summary:	A 57-year-old woman presented with swelling and thickening of the skin of the lower extremities. Three months prior to presentation, patient had MRI with gadolinium as part of an evaluation for suspected pancreatic malignancy. Creatinine levels at the time of gadolinium exposure were 0.9–1.2 mg/dL, with a corresponding estimated glomerular filtration rate of 64 mL/min/1.73m2 by modification of diet in renal disease equation. Twenty-four-hour urine creatinine clearance was performed as an outpatient following development of symptoms. This revealed a creatinine clearance of 23 mL/min, suggestive of advanced chronic kidney disease despite an estimated glomerular filtration rate of 64 mL/min/1.73m2. Skin biopsy was positive for sclerosing dermopathy. These findings, in addition to the temporal association with gadolinium exposure, led to the diagnosis of nephrogenic systemic fibrosis.
ISSN:	1757-790X 1757-790X
DOI:	10.1136/bcr-2017-221016