The causes of chronic renal failure: a radiological characterization

Chronic renal insufficiency produces conditions in which radiographic visualization of the urinary tract may be difficult. In the face of a chronically and markedly elevated BUN, ordinary excretion urography may produce poor visualization at best. Other techniques are available to augment intravenous pyelography, and of these the high dose or drip infusion pyelogram may be especially helpful. Seldom will retrograde urography be required to exclude obstruction. In recent years, renal arteriography has proven to be valuable in the study of the patient with chronic renal failure. While the arterial pattern in end stage renal disease may be insufficiently characteristic to permit a specific diagnosis to be made, the amount of functioning renal parenchyma can be assessed as a guide to therapy and prognostication of outcome. The commonest causes of chronic renal failure are chronic glomerulonephritis and pyelonephritis. The radiographic, pyelographic and angiographic findings in these conditions have been described in detail. In addition, less common but still important causes of chronic renal failure have been radiologically defined and illustrated. It is concluded that the application of appropriate radiologic procedures to the study of the patient with chronic renal failure can greatly extend the nephrologist's ability to secure the correct diagnosis, estimate the stage of the disease and the amount of surviving functioning renal parenchyma, and formulate a meaningful prognosis.