What is the role of computer tomography (CT) in the workup of azotemia?

Updated: Sep 19, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Computed tomography (CT) [9] is complementary to ultrasonography, especially when the diagnosis is uncertain. Contrast nephrotoxicity should be weighed against the benefits. CT is used for the following purposes:

  • Differentiation of neoplastic lesions from simple cysts (in most cases)

  • Radiologic diagnosis of renal stone disease, including radiolucent stones

  • Evaluation and staging of renal cell carcinoma

  • Diagnosis of renal vein thrombosis

  • Diagnosis of polycystic kidney disease; it is more sensitive than ultrasonography for this task, particularly in younger patients

Knipp et al describe successful use of a technique for computed tomographic angiography (CTA) of the abdomen and pelvis in azotemic patients that uses a reduced iodinated contrast volume and low kilovolt (peak) [80-kV(p)] with iterative reconstruction. Their retrospective study in 103 patients with end-stage renal disease found that this technique allows for satisfactory abdominal/pelvic CTA with a 50% reduction in contrast volume and a 43% mean radiation dose reduction, , compared with a standard 120-kV(p) CTA protocol. [10]


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