Key Clinical Message Nephrogenic systemic fibrosis ( NSF ) is a fibrosing disorder seen in patients with renal dysfunction, commonly precipitated by administration of gadolinium contrast. There is no consistently successful treatment, but oral steroids, topical dovonex, extracorporeal photopheresis, and plasmapheresis have been tried [ http://www.icnfdr.org/ Last accessed: 1/6/2017]. Avoidance of gadolinium in such patients is the key to prevention.