Imaging Pearls ❯ Kidney ❯ Contrast
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- Purpose: To determine whether patients with a solitary kidney are at higher risk for contrast material–induced acute kidney injury (AKI) than matched control patients with bilateral kidneys.
Conclusion: Our study did not demonstrate any significant differences in the rate of AKI, dialysis, or death attributable to contrast-enhanced CT in patients with a solitary kidney versus bilateral kidneys. Is the Presence of a solitary Kidney an independent risk Factor for acute Kidney injury after contrast-enhanced CT? McDonald JS et al. Radiology 2016; 278:74–81 - “After propensity score matching, the rate of acute kidney injury (AKI) after contrast material– enhanced CT was similar between patients with solitary versus bilateral kidneys (AKI definition increase in serum creatinine [SCr] level 0.5 mg/dL odds ratio = 1.11 [95% confidence interval {CI}: 0.65, 1.86], P = .70; AKI definition increase in SCr level 0.3 mg/dL or 50% over baseline odds ratio = 0.96 [95% CI: 0.41, 2.07], P = .99).” Is the Presence of a solitary Kidney an independent risk Factor for acute Kidney injury after contrast-enhanced CT? McDonald JS et al. Radiology 2016; 278:74–81
- “The rate of emergent dialysis was rare and also not significantly different between patients with solitary versus bilateral kidneys (0.8% [two of 247 patients] vs 0.4% [three of 691 patients], respectively; odds ratio = 1.87 [95% CI: 0.16, 16.4]; P = .61).” Is the Presence of a solitary Kidney an independent risk Factor for acute Kidney injury after contrast-enhanced CT? McDonald JS et al. Radiology 2016; 278:74–81
- When is a contrast enhanced scan needed?
• unilateral renal stranding/enlargement with risk factors for renal infarct or vein thrombosis (ie, patients with dysrhythmia, thromboembolic disease history, or elevated levels of lactate dehydrogenase)
• perirenal fluid collection
• renal mass/complicated cyst
• unexplained hematuria
- “ Split bolus MDCT urography detected all proven cases of tumors of the upper urinary tract, yielding both high sensitivity and specificity. The split bolus technique has the potential to reduce both radiation dose and the number of images generated by MDCT Urography.”
Split-Bolus MDCT Urography with Synchronous Nephrographic and Excretory Phase Enhancement
Chow LC et al.
AJR 2007; 189:314-322 - “ 40 mL was administered at a rate of 2 mL/s after the unenhanced phase. After a 4-minute delay, an additional 80 mL was administered at 2 mL/s and the abdominal compression devise was inflated. The contrast enhance, breath hold abdominal phase images were acquired 120 seconds after the second contrast bolus, yielding images in synchronous nephrographic and excretory phases of enhancement.”
Split-Bolus MDCT Urography with Synchronous Nephrographic and Excretory Phase Enhancement
Chow LC et al.
AJR 2007; 189:314-322
- Renal Medullary Hyperattenuation on CT: Facts
- Normal variant and may be due to- Hydration status
- Owing to precipitation of drugs in the collecting tubules
- Possible indicator of nephrocalcinosis
- High medullary sodium chloride calcification