Thursday, February 23, 2012

Nephrogenic Systemic Fibrosis and Hypophosphatemia

This is an abstract, where I missed going to the poster at the ACR 2011 Meeting in Chicago. I miss this very much, as I’ve seen two of these patients during the past 20 years. One around 1997/1998 and another one around 2009, both male.

Elana J. Bernstein and collegues present a case-control study of 29 patients. “Nephrogenic systemic fibrosis (NSF) manifests as hardening, tethering, and hyperpigmentation of skin; flexion contractures of joints; and extracutaneous fibrosis in individuals with chronic kidney disease (CKD) …”. Some, but not all patients develop this condition after gadolinium exposure. “Patients with NSF had significantly lower phosphorus levels compared to controls…”. So this study suggests differences in phosphorus metabolism.

[TUE] 2309
Hypophosphatemia Is Associated with Nephrogenic Systemic Fibrosis: A Case-Control Study.
Elana J. Bernstein1, Tamara Isakova2, Mary E. Sullivan3, Lori B. Chibnik4, Hasan Bazari3, Myles Wolf2 and Jonathan Kay5.
1Hospital for Special Surgery, New York, NY, 2University of Miami, Miami, FL, 3Massachusetts General Hospital, Boston, MA, 4Brigham & Women’s Hospital, Boston, MA, 5University of Massachusetts Medical School, Worcester, MA
Results: Subjects were predominantly male (62%), and the majority identified themselves as Caucasian (79%). The mean age of subjects was 63 years (SD 12). Patients with NSF had significantly lower phosphorus levels compared to controls (3.4 _ 0.87 mg/dL vs. 4.49 _ 1.05 mg/dL, p _ 0.01). Accounting for the use of phosphate binders did not alter these results. There were no significant differences in calcium (9.53 _ 0.92 mg/dL vs. 9.64 _ 0.58 mg/dL, p _ 0.70), 25-hydroxy-vitamin D (29.53 _ 23.90 ng/mL vs. 26.90 _ 15.00 ng/mL, p _ 0.74), or FGF23 (8468 _ 8560 RU/mL vs. 6956 _ 4785 RU/mL, p _ 0.79) levels between NSF patients and controls.
Conclusion: This case-control study suggests that differences in phosphorus metabolism may exist between patients with stage 5 CKD and NSF compared to patients with stage 5 CKD without NSF. Further study of the possible pathogenic role of altered phosphorus handing in the development of NSF is therefore needed.

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