The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Renal Failure to-creatinine ratio is a sensitive and specific marker for CKD. Abnormal histology on kidney biopsy or structural abnormalities on imaging (small echogenic kidneys, dysplastic or polycystic kidneys, renal scarring, hydronephrosis) will also qualify as CKD [8]. Special Imaging Considerations The use of iodinated contrast or gadolinium-based contrast agents merits special discussion in the context of renal failure. Generally, iodinated contrast is avoided in AKI unless there is an over-riding clinical question that cannot be answered with an alternative imaging modality or when an intravascular intervention is required [9]. Avoidance of other nephrotoxic drugs, adequate hydration, and close assessment are part of the management. In CKD, the risk- benefit ratio is determined by the level and acuity of kidney disease, specifically weighing the benefits versus risks of any contrast agent. Patients already on hemodialysis or peritoneal dialysis may undergo contrast-enhanced CT if there is no residual renal function. For MRI, there are risk-benefit considerations with respect to the type of gadolinium-based contrast agents. Unenhanced MR angiography (MRA) techniques may be diagnostic. Group II gadolinium-based contrast agents, and lowest diagnostic contrast dose should be standard for contrast-enhanced MRA. Patients already on hemodialysis may undergo contrast-enhanced MRI with group II agents if safety guidelines are followed. For more details please refer to the ACR Manual on Contrast Media [9].
Renal Failure. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Renal Failure to-creatinine ratio is a sensitive and specific marker for CKD. Abnormal histology on kidney biopsy or structural abnormalities on imaging (small echogenic kidneys, dysplastic or polycystic kidneys, renal scarring, hydronephrosis) will also qualify as CKD [8]. Special Imaging Considerations The use of iodinated contrast or gadolinium-based contrast agents merits special discussion in the context of renal failure. Generally, iodinated contrast is avoided in AKI unless there is an over-riding clinical question that cannot be answered with an alternative imaging modality or when an intravascular intervention is required [9]. Avoidance of other nephrotoxic drugs, adequate hydration, and close assessment are part of the management. In CKD, the risk- benefit ratio is determined by the level and acuity of kidney disease, specifically weighing the benefits versus risks of any contrast agent. Patients already on hemodialysis or peritoneal dialysis may undergo contrast-enhanced CT if there is no residual renal function. For MRI, there are risk-benefit considerations with respect to the type of gadolinium-based contrast agents. Unenhanced MR angiography (MRA) techniques may be diagnostic. Group II gadolinium-based contrast agents, and lowest diagnostic contrast dose should be standard for contrast-enhanced MRA. Patients already on hemodialysis may undergo contrast-enhanced MRI with group II agents if safety guidelines are followed. For more details please refer to the ACR Manual on Contrast Media [9].