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Also, there are reports of involvement of deeper structures and organs in the human body, but the confirmation of systemic involvement is complicated by overlap of other disease processes that occur in patients with severe renal impairment. The disorder leads to significant disability and is an important contributing factor of death. Virtually all patients who developed NSF suffered from endstage renal disease (ESRD) or severe chronic kidney disease (CKD) or from an acute acquired kidney injury (AKI). There is an increase in evidence that a causal relation between gadolinium\u2010based contrast agents (Gd\u2010CA) and NSF is probable. Therefore, advanced kidney injury and the exposure to Gd\u2010CA are regarded as prerequisites to develop NSF. Overall, the prognosis is poor and there is no established therapy that shows a consistent benefit. The purpose of this review is to discuss the clinical spectrum of the disease. The clinical presentation, role of co\u2010morbidity in disease development and manifestation, time course, prognosis, outcome, and epidemiological aspects are especially reviewed. J. Magn. Reson. Imaging 2009;30:1289\u20131297. \u00a9 2009 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/jmri.21975","type":"journal-article","created":{"date-parts":[[2009,11,24]],"date-time":"2009-11-24T15:31:40Z","timestamp":1259076700000},"page":"1289-1297","source":"Crossref","is-referenced-by-count":25,"title":["Nephrogenic systemic fibrosis: Clinical spectrum of disease"],"prefix":"10.1002","volume":"30","author":[{"given":"Michael","family":"Mayr","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Burkhalter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Bongartz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,11,24]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.139.7.928"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yadr.2007.07.002"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02694-5"},{"key":"e_1_2_8_5_2","first-page":"25","article-title":"Fibrosing skin condition among patients with renal disease\u2014United States and Europe, 1997\u20132002","volume":"51","author":"Centers for Disease Control and Prevention (CDC)","year":"2002","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000372-200110000-00001"},{"issue":"2","key":"e_1_2_8_7_2","first-page":"S1","article-title":"K\/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification","volume":"39","year":"2002","journal-title":"Am J Kidney Dis"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.06.024"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.139.7.903"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biocel.2003.10.005"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-006-0055-x"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.08.008"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl294"},{"key":"e_1_2_8_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfk062"},{"key":"e_1_2_8_15_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006060601"},{"key":"e_1_2_8_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2008.02.011"},{"key":"e_1_2_8_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.08335.x"},{"key":"e_1_2_8_18_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/17111243"},{"key":"e_1_2_8_19_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00100108"},{"key":"e_1_2_8_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-008-0977-y"},{"key":"e_1_2_8_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.21368"},{"key":"e_1_2_8_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/RLI.0b013e31815e6277"},{"key":"e_1_2_8_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.22925"},{"key":"e_1_2_8_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002281-200311000-00017"},{"key":"e_1_2_8_25_2","first-page":"137","article-title":"Nephrogenic fibrosing dermopathy associated with exposure to gadolinium\u2010containing contrast agents\u2014St. Louis, Missouri, 2002\u20132006","volume":"56","year":"2007","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_8_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm261"},{"key":"e_1_2_8_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-008-0862-6"},{"key":"e_1_2_8_28_2","unstructured":"CowperSE. 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