BMJ Case Reports 2017; doi:10.1136/bcr-2017-221016
  • Reminder of important clinical lesson

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

  1. Alexandra Halalau1,3
  1. 1Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
  2. 2Department of Nephrology, William Beaumont Hospital, Royal Oak, Michigan, USA
  3. 3Oakland University, William Beaumont School of Medicine, Rochester, Michigan, USA
  1. Correspondence to Dr Sadichhya Lohani, sadichhya.lohani{at}
  • Accepted 23 August 2017
  • Published 11 October 2017


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.


  • Contributors SL, JG, AS and AH have substantially contributed to the intellectual content and design of the manuscript including acquisition, interpretation of the data, drafting, and revision of the manuscript. All coauthors agree to be accountable for all aspects of the manuscript and questions related to accuracy and integrity of any part of the manuscript. We assure that all the authors included in the paper fulfill the criteria of authorship. We also assure that there is no one else who fulfills the criteria that have been excluded as an author. SL: designing of the manuscript including the content, drafting, data acquisition, analysis and revision. JG: designing, data acquisition, and revision. AS: intellectual content, revision, data acquisition and interpretation. AH: designing, planning, drafting, intellectual content and revision.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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