Nephrogenic Systemic Fibrosis and Diabetes Mellitus

O ver the past decade, specialists in all areas of medicine have become increasingly aware of and interested in nephrogenic systemic fibrosis (NSF), yet much of this devastating disease’s pathogeny remains a mystery. Many risk factors have been implicated, including liver disease, erythropoietin, proinflammatory and hypercoagulable conditions, dialysis, and gadolinium exposure. Diabetes mellitus (DM) and renal failure are both associated with fibrosing disorders. While a strong association exists between kidney disease and NSF, diabetes has never before been proposed as a risk factor. The most common cause of renal failure in the United States is DM. Seven percent of the population has diabetes, and every third patient with DM develops nephropathy, accounting for about 45% of endstage renal disease (ESRD). Herein, we review 295 cases of NSF to determine if diabetes could be a risk factor for NSF development.