Renal Imaging in Patients with Renal Impairment

Abstract

In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects. This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with emphasis on non-contrast-enhanced magnetic resonance imaging.

Imaging patients with renal impairment

“…A monomer has one benzene ring, while a dimer has two [18]. As a result, IBCAs can be further subdivided into four groups: ionic monomer, ionic dimer, non-ionic monomer, or non-ionic dimer (see Table 1) [1]. Ionic monomer agents have a serum osmolality approximately five to eight times above normal serum and are considered high-osmolar contrast agents [1].…”

“…As a result, IBCAs can be further subdivided into four groups: ionic monomer, ionic dimer, non-ionic monomer, or non-ionic dimer (see Table 1) [1]. Ionic monomer agents have a serum osmolality approximately five to eight times above normal serum and are considered high-osmolar contrast agents [1]. IBCAs with such characteristics have been associated with higher rates of acute and nephrotoxic adverse events and are thus rarely used in current clinical practice [19].…”

“…IBCAs with such characteristics have been associated with higher rates of acute and nephrotoxic adverse events and are thus rarely used in current clinical practice [19]. Ionic dimer and non-ionic monomer agents have a serum osmolality of approximately twice the normal levels and are thus considered low-osmolar agents [1]. Non-ionic dimer agents demonstrate a serum osmolality similar to normal serum and are considered iso-osmolar agents [1].…”

“…However, as renal function deteriorates, the potential risk of nonallergic-type adverse events increases [1]. This presents a clinical conundrum when the use of intravenous contrast media is deemed essential for diagnostic purposes.…”

Assessment with Unenhanced MRI Techniques of Renal Morphology and Hemodynamic Changes during Acute Kidney Injury and Chronic Kidney Disease in Mice

“…The use of iodinated contrast media in computerized tomography (CT) and of gadolinium-based contrast-enhanced MRI (CE-MRI) greatly improves the imaging quality of renal morphology, and provides information regarding the perfusion and excretory capacity of the kidneys. Yet, the use of these imaging techniques is limited in AKI and CKD patients, since it harbors the risk of worsening renal function and the development of nephrogenic systemic fibrosis, respectively [6,7]. …”