Safe Imaging Options for Monitoring Polycystic Liver and Kidney Disease

Q: Safe Imaging Options for Monitoring Polycystic Liver and Kidney Disease

Hello： Based on the information you provided, your kidney function (GFR = 69 cc/min) is estimated to be at stage 2 chronic kidney disease (mild decrease in kidney function). <br>If a CT scan is absolutely necessary, it is recommended to use an isotonic contrast agent to minimize

Please provide me with a specific condition or symptom for which you would like a check-up or treatment recommendation. Thank you?

Hello Dr.
Tsai, I am 169 cm tall and weigh 75 kg.
I do not smoke or drink alcohol, and I have no history of drug allergies.
I had allergic rhinitis and asthma as a child, and I have had pneumonia.
Currently, I have hypertension and am under follow-up treatment for thyroid cancer.
I have had surgery for varicose veins in my legs, which has been cured.
I also have gastroesophageal reflux disease, polycystic liver disease, and polycystic kidney disease, which have been monitored for 20 years.
My kidney function has shown a creatinine level above 1.4, while my liver function is normal.
I have mild depression, which is also under follow-up treatment.

Symptoms: I have polycystic liver and kidney disease, and over the past two years, my abdomen has enlarged from a circumference of 80 cm to about 100 cm now.
My kidney function was tested in early July this year, with a creatinine level of 1.4 and other results normal.
In March of this year, my liver function tests showed a gamma-GTP of 123, while other liver enzymes (AST and ALT) were normal.
In June of last year, my alpha-fetoprotein (AFP) was normal.
In early July, I had an abdominal ultrasound at a clinic to monitor the status of my polycystic liver and kidney disease, which I hadn’t done in about two years.
The doctor noted that the liver cysts had significantly enlarged and recommended a referral to a larger hospital for a CT scan.

I subsequently visited Mackay Memorial Hospital in Taipei, where I underwent a fecal occult blood test and an abdominal ultrasound.
The results were: fecal occult blood: negative; numerous and large liver cysts, with the largest measuring about 6 cm.
The liver could not be fully visualized unless a CT scan was performed.
There was one gallstone measuring 0.5 cm in diameter, and the doctor advised that I could continue to monitor it.
Additionally, the doctor recommended follow-up every six months or to return if I experience discomfort.
The CT scan is optional, and I can decide for myself.
My question is, I have heard that undergoing a CT scan requires a significant amount of contrast agent, which could negatively impact my kidney function (due to polycystic kidney disease and existing chronic kidney failure).
Should I proceed with the CT scan to observe my abdominal condition? Is it possible to perform a CT scan without using contrast? Would a high-resolution ultrasound be sufficient to assess my abdomen? Please provide me with a recommendation for a test that would not adversely affect my kidney function.
Thank you!

eric, 50~59 year old female. Ask Date: 2012/08/23

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Based on the information you provided, your kidney function (GFR = 69 cc/min) is estimated to be at stage 2 chronic kidney disease (mild decrease in kidney function).
If a CT scan is absolutely necessary, it is recommended to use an isotonic contrast agent to minimize the impact of the contrast on the kidneys.
Furthermore, since there is already a known issue of polycystic kidney disease and polycystic liver disease, it is not advisable to perform a CT scan solely to evaluate these conditions.
A CT scan should only be considered if an ultrasound reveals abnormal findings within the cysts, or if there are symptoms such as abdominal pain or fever suggesting cyst infection, or if the cysts are significantly enlarged and need assessment for compression of surrounding organs.
Non-contrast CT scans also have diagnostic value, but they do provide significantly less information compared to contrast-enhanced CT scans.
Advanced ultrasound is primarily used to assess fetal development, while standard ultrasound is generally sufficient for evaluating polycystic kidney and liver conditions.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2012/08/23

More Info

When considering safe imaging options for monitoring polycystic liver and kidney disease (PLKD), especially in the context of your current health status, there are several factors to weigh, particularly regarding the potential impact of imaging modalities on kidney function.

Given your history of chronic kidney disease (CKD) with a serum creatinine level of 1.4 mg/dL, it is crucial to minimize any additional stress on your kidneys. The use of iodinated contrast agents in CT scans can pose a risk for patients with compromised renal function, as it may lead to contrast-induced nephropathy (CIN). Generally, the risk of CIN increases significantly when the estimated glomerular filtration rate (eGFR) falls below 30 mL/min. However, even with an eGFR around 69 mL/min, caution is warranted, especially since you have a history of polycystic kidney disease, which can further complicate renal function.

1. CT Scans with Contrast: While CT scans are highly effective for detailed imaging of the liver and kidneys, the use of contrast agents can be concerning. In your case, it is advisable to discuss with your healthcare provider the possibility of using a low-osmolar or iso-osmolar contrast agent, which may reduce the risk of nephrotoxicity. Additionally, hydration before and after the procedure can help mitigate risks. However, if your physician believes that the benefits of a CT scan with contrast outweigh the risks, it may still be considered.

2. CT Scans without Contrast: It is indeed possible to perform a CT scan without contrast. While this may provide less detailed information compared to a contrast-enhanced scan, it can still be useful for assessing the size and number of cysts in the kidneys and liver. This option significantly reduces the risk of affecting your renal function.

3. Ultrasound: Given your situation, a high-resolution ultrasound is an excellent alternative for monitoring PLKD. Ultrasound is non-invasive, does not involve radiation, and does not require contrast agents, making it a safe choice for patients with kidney concerns. It can effectively visualize cysts in the liver and kidneys and monitor any changes in size or number over time. Regular ultrasounds can provide valuable information without the risks associated with CT scans.

4. MRI: Magnetic Resonance Imaging (MRI) is another imaging modality that can be considered. While some MRI studies may require gadolinium-based contrast agents, which can also pose risks for patients with renal impairment, non-contrast MRI can still provide detailed images of the liver and kidneys. It is important to discuss this option with your healthcare provider, as they can assess the appropriateness based on your specific health status.

5. Follow-Up and Monitoring: Given that your physician has recommended regular follow-ups, it is essential to adhere to a monitoring schedule. This may include periodic ultrasounds every six months or as needed based on your symptoms. If any significant changes occur, such as increased abdominal pain or changes in kidney function, further imaging may be warranted.

In conclusion, for monitoring polycystic liver and kidney disease in your case, a high-resolution ultrasound is likely the safest and most effective option, minimizing the risk to your renal function. If further imaging is necessary, discuss the possibility of a non-contrast CT scan or MRI with your healthcare provider. Always ensure that any imaging decisions are made collaboratively with your medical team, considering both the benefits and risks involved.

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