Renal Failure (Acute or Acute on Chronic)
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Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with new onset or acutely worsening renal failure.
Date reviewed: January 2012
Date of next review: October 2023
Published: January 2012
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1a |  |
Acute on Chronic Renal Failure Image 1a, 1b, 1c (Right Kidney - Ultrasound), 1d and 1e (Left Kidney - Ultrasound): Both kidneys are small and echogenic. The right kidney measures 7.8cm and the left kidney measures 8.9cm. There is no evidence of hydronephrosis and no renal calculi are seen. No vascular flow could be demonstrated within the parenchyma one either side. No collection is seen around either kidney. The bladder which is not illustrated here is well distended without focal abnormality. Vesicoureteric jets could not be visualised. These images are consistent with a chronic process such as a vasculitis. |
| 1b |  |
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| 1c |  |
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| 1d |  |
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| 1e |  |
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Teaching Points
Teaching Points
- Ultrasound is the modality of choice and is used to exclude obstructive uropathy and to assess renal size and contour
- In the absence of obstruction and evidence of pre-renal failure, the size and contour of the kidneys can be useful to assess the underlying cause of the renal failure
- Further imaging in non-obstructive uropathy depends on the provisional diagnosis. For example Doppler US may be used to assess for renal artery stenosis
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Mucelli RP, Bertolotto M. Imaging techniques in acute renal failure. Kidney Int Suppl. 1998;53(S66):S102-5. (Review article)
- O'Neill WC. Sonographic evaluation of renal failure. Am J Kidney Dis. 2000;35(6):1021-38. (Review article)
- Gottlieb RH, Weinberg EP, Rubens DJ, et al. Renal sonography: can it be used more selectively in the setting of an elevated serum creatinine level? Am J Kidney Dis. 1997;29:362-7. (Level III evidence)
- Platt JF. Advances in ultrasonography of urinary tract obstruction. Abdom Imaging. 1998;23:3-9. (Review article)
- Platt JF. Doppler ultrasound of the kidney. Semin Ultrasound CT MR. 1997;18:22-32. (Review article)
- Platt JF. Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol. 1992;158:1035-42. (Review article)
- Fresco GF, DiGiorgio F, Curti GL. Simultaneous estimation of glomerular filtration rate and renal plasma flow. J Nucl Med. 1995;36(9):1701-6. (Level III evidence)
- Blaustein DA, Myint MM, Babu K, et al. The role of technetium-99m MAG3 renal imaging in the diagnosis of acute tubular necrosis of native kidneys. Clin Nucl Med. 2002;27:165-8. (Level IV evidence)
- Woolfson RG, Neild GH. The true clinical significance of renography in nephro-urology. Eur J Nucl Med. 1997;24(5):557-70. (Review article)
- Vasbinder GBC, Nelemans PJ, Kessels AGH, et al. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med. 2001;135:401-11. (Level I/II evidence). View the reference
- Radermacher J, Chavan A, Bleck J, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med. 2001;344:410-7. (Level I/II evidence). View the reference
- Krijnen P, Van Jaarsveld BC, Steyerberg EW, et al. A clinical prediction rule for renal artery stenosis. Ann Intern Med. 1998;129:705-11. (Level II evidence). View the reference
- Pedersen EB. New tools in diagnosing renal artery stenosis. Kidney Int. 2000;57:2657-77. (Review article)
- Rankin SC, Saunders AJS, Cook GJR, et al. Renovascular disease. Clin Radiol. 2000;55:1-12. (Review article)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Iodine-Containing Contrast Medium Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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