Renal failure (acute or acute-on-chronic)

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 Published: January 2012

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.

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.

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.

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.

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.

Acute on Chronic Renal Failure

  • 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 are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Mucelli RP, Bertolotto M. Imaging techniques in acute renal failure. Kidney Int Suppl. 1998;53(S66):S102-5. (Review article)
  2. O'Neill WC. Sonographic evaluation of renal failure. Am J Kidney Dis. 2000;35(6):1021-38. (Review article)
  3. 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)
  4. Platt JF. Advances in ultrasonography of urinary tract obstruction. Abdom Imaging. 1998;23:3-9. (Review article)
  5. Platt JF. Doppler ultrasound of the kidney. Semin Ultrasound CT MR. 1997;18:22-32. (Review article)
  6. Platt JF. Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol. 1992;158:1035-42. (Review article)
  7. 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)
  8. 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)
  9. Woolfson RG, Neild GH. The true clinical significance of renography in nephro-urology. Eur J Nucl Med. 1997;24(5):557-70. (Review article)
  10. 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
  11. 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
  12. 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
  13. Pedersen EB. New tools in diagnosing renal artery stenosis. Kidney Int. 2000;57:2657-77. (Review article)
  14. Rankin SC, Saunders AJS, Cook GJR, et al. Renovascular disease. Clin Radiol. 2000;55:1-12. (Review article)

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Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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