How are nerve conduction abnormalities assessed in the workup of nephrogenic systemic fibrosis (NSF)?

Updated: May 22, 2018
  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Abnormalities of nerve conduction have been described in some patients.

Thakral and Abraham [60] developed an automated quantitative scanning electron microscopy and energy dispersive x-ray spectroscopy method for documenting gadolinium in tissue of patients with nephrogenic systemic fibrosis. They examined, under standardized conditions, freshly cut tissue in paraffin block using the variable pressure mode. This allowed them to perform a random search of the tissue area to conduct in situ detection and semiquantitative morphometric (volumetric) analysis of insoluble, higher–atomic number features using backscattered electron imaging.

Paraffin-embedded tissue, lesional, nonlesional, and fresh tissue, as well as serum, can all show elevated levels of gadolinium in nephrogenic systemic fibrosis. [61]

Thakral and Abraham detected gadolinium ranging from 1-2270 cps/mm2 in 57 cutaneous biopsy specimens of nephrogenic systemic fibrosis. Gadolinium was associated with phosphate, calcium, and sodium in the tissues. This method reproducibly determines the elemental composition, relative concentration, and spatial distribution of detected features within the tissue; however, they could not detect features below their spatial resolution or concentrations below the detection limit of the scanning electron microscopy and energy dispersive x-ray spectroscopy system.

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