Nephrogenic systemic fibrosis: what internists need to know.

Nephrogenic systemic fibrosis (NSF) is an emerging entity that affects the skin and internal organs in patients with renal insufficiency and may end in death. More than 215 cases have been reported to the NSF registry at Yale University and more than 700 cases have been reported world-wide. There is a growing concern about gadolinium contrast media as being the major player in NSF development. Given the lack of established effective therapy, gadolinium avoidance along with careful consideration of the predisposing factors is the vital approach. Clinicians must be aware of the risks and benefits of gadolinium administration especially in patients with chronic kidney disease.