Imaging in the Dialysis Patient: Renal Imaging in Patients Requiring Renal Replacement Therapy

Abstract

Recent advances in imaging technology and interventional radiologic procedures have resulted in an increased variety of radiological techniques that can be used to assess patients who present with renal failure and require renal replacement therapy. This chapter provides an overview of the relative strengths and weaknesses of the available imaging methods. In particular, it covers the expanding role of the cross-sectional, noninvasive, multiplanar imaging techniques such as gray-scale and Doppler ultrasound, magnetic resonance imaging (MRI) and angiography (MRA), and nonenhanced helical or multislice computed tomography (CT). These imaging methods are increasingly replacing those used in the past, such as the conventional radiographic urogram, which requires a high dose of intravenous contrast media, and digital subtraction arteriography. The chapter also covers the radiologic investigation of complications of acquired renal cystic disease, including renal cell carcinoma, hemorrhage, cyst infection and rupture, and nephrolithiasis.

Who should have pelvic vessel imaging prior to renal transplantation?

“…Administration of iodinated contrast leading to CIN is of little clinical consequence in patients with established ESRD (GFR < 15 ml/min) who are receiving RRT and produce little or no urine (17). In such instances, the usage of CTA is a favorable alternative owing to its equivalent diagnostic accuracy with MRA (14, 16) and thus obviating the need to utilize gadolinium‐based contrast agents, hence eliminating the risk of developing NSF.…”

“…A recent systematic review and meta‐analysis reported a sensitivity and specificity of detecting solely significant stenotic or occlusive aortoiliac disease of 96% (91–99%) and 98% (95–99%), respectively (16). However, ionizing radiation and the required use of potentially nephrotoxic iodinated contrast agents are of concern in patients with ESRD depending on the mode of dialysis and the presence or absence of residual renal function (RRF) (17–21).…”