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MRI Can Lead to Incurable Disease Part V

Tuesday, 4th November 2008

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Gadolinium injection used to get a better MRI image can cause nephrogenic fibrosing dermopathy (NFD) or nephrogenic systemic fibrosis (NSF) in people with kidney problems.

NFD/NSF: How Is It Diagnosed?

Definitive diagnosis of NFD/NSF is made by full-thickness skin biopsy at the involved site. Characteristic histological findings include thickened reticular dermal collagen bundles with dermal spindle cells that stain positive for both CD34 and procollagen.  Cowper SE (2003) Nephrogenic fibrosing dermopathy: the first 6 years. Curr Opin Rheumatol 15: 785-790

Definitions:

●    reticular   = netlike pattern
●    collagen is tiny inelastic protein fibers that make up connective tissue such as ligaments and tendons and it is also the ingredient of scar tissue.
●    spindle cell: A cell that is tapered at both ends.
●    CD34 antigen is a  protein found on the surface of some bone marrow and blood cells.
●    An antigen is a substance which is foreign to the body which causes the body to form an antibody
●    antigens can cause allergic reactions
●    An antibody is a chemical formed by the body to defend it against virus, bacteria or other foreign bodies (antigens) Anything which is not naturally a part of the body is considered an antigen.   The antibody molecules surround the foreign bodies and try to outnumber them and keep them from multiplying
●    procollagen is the forefunner of collagen so it is formed during the development of collagen

So, in summary, a definitive diagnosis of NFD/NSF is accomplished through biopsy of the affected area followed by microscopic examination of the cells and tissue from the biopsy which shows bundles of collagen showing a netlike pattern and skin cells that are tapered at both ends and then lab tests confirm the presence of the CD 34 antigen and of procollagen.

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