What are considerations prior to performing renal cell carcinoma imaging in patients with renal insufficiency?

Updated: Dec 13, 2018
  • Author: Deborah A Baumgarten, MD, MPH; Chief Editor: Eugene C Lin, MD  more...
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In patients with renal insufficiency, avoiding or limiting intravenous iodinated contrast material and ensuring adequate hydration is best if the creatinine levels are above 2 and if the patient is not receiving long-term dialysis. Poor renal function also results in failure to opacify the kidneys and collecting system, limiting evaluation of the kidneys. In patients with renal insufficiency, MRI is an excellent alternative to CT.

Another consideration in patients with abnormal renal function not yet requiring dialysis is that nephrectomy will likely result in dialysis dependence. In these patients, accurate diagnosis and staging is imperative and is probably best accomplished by using contrast-enhanced MRI.

In patients already undergoing dialysis, iodinated contrast material does not need to be avoided, and in fact CT is preferable to MRI due to the small but documented risk of nephrogenic systemic fibrosis (NSF).

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