Imaging patients with chronic kidney disease: CIN or NSF?

Patients with chronic kidney disease (CKD) frequently require contrast-enhanced imaging studies in order to manage their condition. Radiologists are often confronted with selecting the best imaging modality for each patient based on the patient's degree of renal impairment. In the past, when patients required a contrast-enhanced imaging study, the tendency was to select magnetic resonance (MR) imaging with a gadolinium (Gd)-based contrast agent over computed tomography (CT) with iodinated contrast media (CM) due to the known nephrotoxic nature of iodinated CM, which is associated in some patients with the development of contrast-induced nephropathy (CIN). However, recently, the administration of Gd-based contrast agents has been associated with a severe, potentially fatal, adverse reaction, termed nephrogenic systemic fibrosis (NSF), in patients with moderate-to-severe renal insufficiency. Therefore, this same patient population is now at risk for developing either CIN or NSF. In order to optimise patient outcomes, imaging of patients with CKD requires an understanding of the risk factors for both CIN and NSF.