Imaging the urinary tract in the critically ill
- DOI:
- 10.1093/med/9780199600830.003.0210
Imaging the urinary tract of patients in the intensive care unit (ICU) may assist identifying the cause of acute kidney injury (AKI). By the nature of their illness patients on ICU will often be clinically unstable and this will restrict the choice of imaging. Ultrasound is the most commonly used non-invasive imaging technique used, and is essential for assessing renal anatomy, determining kidney size and the presence of obstruction. New developments hold much promise and there are a number of centres now using this technology. Doppler ultrasonography has become increasingly popular to assess intrarenal blood flow. CT scanning can be used with or without contrast when ultrasonography is non-diagnostic and is very useful in identifying calcification within the renal tract. However, the patient must be stable enough for transfer to the radiology department. It is important to consider the risk of iodinated contrast-induced AKI (CI-AKI) in critically-ill patients and minimize potential renal injury. Magnetic resonance imaging may be preferred where there is risk of CI-AKI, but the logistics may prove even more demanding. Renal arteriography is rarely performed, but may be required for diagnostic and interventional procedures for renal artery stenosis or sites of active haemorrhage.
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