Imaging in Chronic Kidney Disease

Abstract

Imaging procedures based on renal excretion of contrast agents or isotopes (e.g., renography, CT-urography, MR-urography) cannot give useful images in patients with severely reduced kidney function (glomerular filtration rate below 30 ml/min/1.73 m²). Furthermore, contrast-enhanced imaging may carry a risk of contrast nephropathy and—in case of Gd-based agents—nephrogenic systemic fibrosis in such patients. However, clinicians should never fail to perform contrast-enhanced imaging to document or exclude life-threatening disease (e.g., coronary occlusions, malignant tumors) in patients with severe renal insufficiency. First, the risk of contrast nephropathy after the use of iodine-based contrast agent may be much lower than previously believed. Second, contrast nephropathy is reversible in most cases. Third, nephrogenic systemic fibrosis has been very seldomly reported after the use of the more chemically unstable gadolinium agents has been abandoned. In other words, the currently used more stable Gd-based agents seem safe even in patients with severe renal insufficiency.