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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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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Abstract	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.
AbstractList	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/1.73m 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/1.73m 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. 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/1.73m 2 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/1.73m 2 . 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. 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.
Author	Halalau, Alexandra Golenbiewski, Jon Swami, Abhishek Lohani, Sadichhya
AuthorAffiliation	1 Department of Internal Medicine , William Beaumont Hospital , Royal Oak , Michigan , USA 2 Department of Nephrology , William Beaumont Hospital , Royal Oak , Michigan , USA 3 Oakland University , William Beaumont School of Medicine , Rochester , Michigan , USA
AuthorAffiliation_xml	– name: 2 Department of Nephrology , William Beaumont Hospital , Royal Oak , Michigan , USA – name: 3 Oakland University , William Beaumont School of Medicine , Rochester , Michigan , USA – name: 1 Department of Internal Medicine , William Beaumont Hospital , Royal Oak , Michigan , USA
Author_xml	– sequence: 1 givenname: Sadichhya orcidid: 0000-0001-9769-1706 surname: Lohani fullname: Lohani, Sadichhya email: sadichhya.lohani@gmail.com organization: Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA – sequence: 2 givenname: Jon surname: Golenbiewski fullname: Golenbiewski, Jon email: sadichhya.lohani@gmail.com organization: Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA – sequence: 3 givenname: Abhishek surname: Swami fullname: Swami, Abhishek email: sadichhya.lohani@gmail.com organization: Department of Nephrology, William Beaumont Hospital, Royal Oak, Michigan, USA – sequence: 4 givenname: Alexandra orcidid: 0000-0002-1805-992X surname: Halalau fullname: Halalau, Alexandra email: sadichhya.lohani@gmail.com organization: Oakland University, William Beaumont School of Medicine, Rochester, Michigan, USA
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Cites_doi	10.1102/1470-7330.2007.0019 10.1016/j.jaad.2009.04.022 10.7326/0003-4819-150-9-200905050-00006 10.1159/000077321 10.3109/00365599.2011.644859 10.1002/jmri.22024 10.1002/jca.21253 10.1111/ajd.12176 10.1159/000151228 10.1001/archdermatol.2009.245 10.1093/ndt/gfk062 10.1515/cclm-2013-0741 10.1111/j.1525-139X.2007.00399.x 10.1001/jamadermatol.2015.0976 10.1007/s00330-015-3842-9 10.1016/j.jaad.2009.03.040 10.1111/j.1525-139X.2007.00407.x
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Snippet	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...
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SubjectTerms	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
Title	A unique case of nephrogenic systemic fibrosis from gadolinium exposure in a patient with normal eGFR
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