Preliminary Diagnosis: Chronic Kidney Disease

I. What imaging technique is first-line for this diagnosis:

  • Gray-scale and color Doppler ultrasound are the first line imaging study to evaluate renal size and parenchyma and to rule out acute obstruction.

II. Describe the advantages and disadvantages of this technique for diagnosis of chronic kidney disease.

  • Ultrasound is readily available.

  • The retroperitoneal location of the kidneys easily allows ultrasound to evaluate renal anatomy.

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  • The primary ultrasound imaging finding in chronic kidney disease is small, echogenic kidneys. Many diseases that result in chronic kidney failure result in increased cortical echogenicity, and ultrasound is limited in its ability to differentiate between them. The primary role of imaging in chronic kidney disease is to rule out reversible causes of renal failure.

  • Evaluation of the ureters is limited secondary to their small size.

III. What are the contraindications for the first-line imaging technique?

No significant contraindications

IV. What alternative imaging techniques are available?

  • Noncontrast CT, intravenous iodinated contrast is contraindicated in advanced renal failure

  • Radionuclide studies

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of chronic kidney disease.

Noncontrast CT
  • CT can also provide information regarding the degree of cortical atrophy, cortical scarring, and renal size.

  • Can evaluate for extrarenal causes of renal failure and their complications such as renal cell carcinoma formation in patients with cystic renal disease acquired from chronic renal failure or dialysis

  • Ionizing radiation

Radionuclide studies
  • 99mTc-MAG3 is a secreted by the renal tubular system and can be used to evalute renal function and physiology

  • Can be used to serially to evaluate disease progression

  • Radiation exposure

  • Certain radionuclide agents are dependent on the underlying renal function.

VI. What are the contraindications for the alternative imaging techniques?

Noncontrast CT

CT and radionuclide studies are contraindicated in early pregnancy secondary to radiation exposure.