Download PDF
CC BY-NC-ND 4.0 · Indographics 2023; 02(02): 095-108
DOI: 10.1055/s-0043-1774757
Review Article

Imaging of Pulmonary Manifestations in Chronic Kidney Disease: A Review

Abanti Das
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Kalyani, West Bengal, India
,
Priyanka Naranje
2   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Ashu Seith Bhalla
2   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Chandan J. Das
2   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Lungs and kidneys share a symbiotic relationship in maintaining homeostasis of body. Hence, derangement of one system is bound to affect the functioning of the other. The thoracic manifestations of chronic renal failure present a wide spectrum ranging from problems related to fluid and salt balance, calcium–phosphate metabolism, compromised immunity, and additional issues related to different modes of dialysis. In most of the cases, chest radiograph coupled with ultrasound and computed tomography (CT) are sufficient to offer a definitive diagnosis. This review aims to summarize the imaging features of thoracic manifestations of chronic kidney disease (CKD) with emphasis on imaging-based discriminating features.

Keywords

chronic kidney disease - pulmonary - pulmonary edema - chest radiograph - CT - pulmonary infection


Publication History

Article published online:
16 October 2023

© 2023. Indographics. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int 2019; 96 (05) 1048-1050
    CrossrefPubMedGoogle Scholar
  • 2 Pierson DJ. Respiratory considerations in the patient with renal failure. Respir Care 2006; 51 (04) 413-422
    PubMedGoogle Scholar
  • 3 Milne EN, Pistolesi M, Miniati M, Giuntini C. The radiologic distinction of cardiogenic and noncardiogenic edema. AJR Am J Roentgenol 1985; 144 (05) 879-894
    CrossrefPubMedGoogle Scholar
  • 4 Fraser R, Paré J, Paré P, Fraser R, Genereux G. Diagnosis of Diseases of the Chest. 3rd ed. Vol. 1887–1968.. Philadelphia, PA: Saunders; 1990
    Google Scholar
  • 5 Gavelli G, Zompatori M. Thoracic complications in uremic patients and in patients undergoing dialytic treatment: state of the art. Eur Radiol 1997; 7 (05) 708-717
    CrossrefPubMedGoogle Scholar
  • 6 Aberle DR, Wiener-Kronish JP, Webb WR, Matthay MA. Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients. Radiology 1988; 168 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 7 Storto ML, Kee ST, Golden JA, Webb WR. Hydrostatic pulmonary edema: high-resolution CT findings. AJR Am J Roentgenol 1995; 165 (04) 817-820
    CrossrefPubMedGoogle Scholar
  • 8 Gowrinath K, Attur RP, Baig WW, Magazine R, Srikanth G, Rajagopal KV. An unusual case of unilateral pulmonary edema in patients with chronic kidney disease. Respir Med CME 2009; 2 (03) 130-133
    CrossrefGoogle Scholar
  • 9 Chandrashekar HB, Ravi R, Sundar S, Ramarao D. Unilateral pulmonary edema: a report of two cases. Indian J Chest Dis Allied Sci 1992; 34 (03) 157-161
    PubMedGoogle Scholar
  • 10 Slanetz PJ, Truong M, Shepard JA, Trotman-Dickenson B, Drucker E, McLoud TC. Mediastinal lymphadenopathy and hazy mediastinal fat: new CT findings of congestive heart failure. AJR Am J Roentgenol 1998; 171 (05) 1307-1309
    CrossrefPubMedGoogle Scholar
  • 11 Ngom A, Dumont P, Diot P, Lemarié E. Benign mediastinal lymphadenopathy in congestive heart failure. Chest 2001; 119 (02) 653-656
    CrossrefPubMedGoogle Scholar
  • 12 Milne EN, Pistolesi M, Miniati M, Giuntini C. The vascular pedicle of the heart and the vena azygos. Part I: the normal subject. Radiology 1984; 152 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 13 Gavelli G, Zompatori M, Bernasconi A, Baldrati L, Buscaroli A, Orsi C. Valutazione radiologica dello stato di idratazione nei pazienti uremici in dialisi periodica. [Radiological evaluation of the state of hydration in uremic patients under periodic dialysis]. Radiol Med (Torino) 1984; 70 (12) 933-936
    PubMedGoogle Scholar
  • 14 di Guglielmo L, Montemartini C. L'esame-diretto del torace nello studio della cardiopatia ischemica. Radiologia Toracica III 1985;109–123 SIRM Cortina, Verona.
  • 15 Covic A, Siriopol D, Voroneanu L. Use of lung ultrasound for the assessment of volume status in CKD. Am J Kidney Dis 2018; 71 (03) 412-422
    CrossrefPubMedGoogle Scholar
  • 16 Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound 2014; 12: 25
    CrossrefPubMedGoogle Scholar
  • 17 Jambrik Z, Monti S, Coppola V. et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 2004; 93 (10) 1265-1270
    CrossrefPubMedGoogle Scholar
  • 18 Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 2006; 19 (03) 356-363
    CrossrefPubMedGoogle Scholar
  • 19 Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J 2016; 37 (27) 2097-2104
    CrossrefPubMedGoogle Scholar
  • 20 Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest 2001; 120 (06) 1883-1887
    CrossrefPubMedGoogle Scholar
  • 21 Viasus D, Garcia-Vidal C, Cruzado JM. et al. Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease. Nephrol Dial Transplant 2011; 26 (09) 2899-2906
    CrossrefPubMedGoogle Scholar
  • 22 Bonomini V, Stefoni S, Vangelista A. et al. Immune system in uremia. In: Davison A. ed. Proceedings of the Xth International Congress of Nephrol: 2. London: Baillére-Tindall; 1987: 1042-1047
    Google Scholar
  • 23 Slinin Y, Foley RN, Collins AJ. Clinical epidemiology of pneumonia in hemodialysis patients: the USRDS waves 1, 3, and 4 study. Kidney Int 2006; 70 (06) 1135-1141
    CrossrefPubMedGoogle Scholar
  • 24 Chen CY, Hsu SC, Hsieh HL. et al. Microbial etiology of pneumonia in patients with decreased renal function. PLoS One 2019; 14 (05) e0216367
    CrossrefPubMedGoogle Scholar
  • 25 Hussein MM, Mooij JM, Roujouleh H. Tuberculosis and chronic renal disease. Semin Dial 2003; 16 (01) 38-44
    CrossrefPubMedGoogle Scholar
  • 26 Segall L, Covic A. Diagnosis of tuberculosis in dialysis patients: current strategy. Clin J Am Soc Nephrol 2010; 5 (06) 1114-1122
    CrossrefPubMedGoogle Scholar
  • 27 Rao TM, Ram R, Swarnalatha G. et al. Tuberculosis in haemodialysis patients: a single centre experience. Indian J Nephrol 2013; 23 (05) 340-345
    CrossrefPubMedGoogle Scholar
  • 28 Taskapan H, Utas C, Oymak FS, Gülmez I, Ozesmi M. The outcome of tuberculosis in patients on chronic hemodialysis. Clin Nephrol 2000; 54 (02) 134-137
    PubMedGoogle Scholar
  • 29 Sasaki S, Akiba T, Suenaga M. et al. Ten years' survey of dialysis-associated tuberculosis. Nephron J 1979; 24 (03) 141-145
    CrossrefPubMedGoogle Scholar
  • 30 Hussein MM, Bakir N, Roujouleh H. Tuberculosis in patients undergoing maintenance dialysis. Nephrol Dial Transplant 1990; 5 (08) 584-587
    CrossrefPubMedGoogle Scholar
  • 31 Abbott KC, Hypolite I, Tveit DJ, Hshieh P, Cruess D, Agodoa LY. Hospitalizations for fungal infections after initiation of chronic dialysis in the United States. Nephron J 2001; 89 (04) 426-432
    CrossrefPubMedGoogle Scholar
  • 32 Oyelade T, Alqahtani J, Canciani G. Prognosis of COVID-19 in patients with liver and kidney diseases: an early systematic review and meta-analysis. Trop Med Infect Dis 2020; 5 (02) 80
    CrossrefPubMedGoogle Scholar
  • 33 Kuhlman JE, Ren H, Hutchins GM, Fishman EK. Fulminant pulmonary calcification complicating renal transplantation: CT demonstration. Radiology 1989; 173 (02) 459-460
    CrossrefPubMedGoogle Scholar
  • 34 Bush A, Gabriel R. Pulmonary function in chronic renal failure: effects of dialysis and transplantation. Thorax 1991; 46 (06) 424-428
    CrossrefPubMedGoogle Scholar
  • 35 Sanders C, Frank MS, Rostand SG, Rutsky EA, Barnes GT, Fraser RG. Metastatic calcification of the heart and lungs in end-stage renal disease: detection and quantification by dual-energy digital chest radiography. AJR Am J Roentgenol 1987; 149 (05) 881-887
    CrossrefPubMedGoogle Scholar
  • 36 Lingam RK, Teh J, Sharma A, Friedman E. Case report. Metastatic pulmonary calcification in renal failure: a new HRCT pattern. Br J Radiol 2002; 75 (889) 74-77
    CrossrefPubMedGoogle Scholar
  • 37 Hartman TE, Müller NL, Primack SL. et al. Metastatic pulmonary calcification in patients with hypercalcemia: findings on chest radiographs and CT scans. AJR Am J Roentgenol 1994; 162 (04) 799-802
    CrossrefPubMedGoogle Scholar
  • 38 Brown K, Mund DF, Aberle DR, Batra P, Young DA. Intrathoracic calcifications: radiographic features and differential diagnoses. Radiographics 1994; 14 (06) 1247-1261
    CrossrefPubMedGoogle Scholar
  • 39 Guermazi A, Espérou H, Selimi F, Gluckman E. Imaging of diffuse metastatic and dystrophic pulmonary calcification in children after haematopoietic stem cell transplantation. Br J Radiol 2005; 78 (932) 708-713
    CrossrefPubMedGoogle Scholar
  • 40 Thurley PD, Duerden R, Roe S, Pointon K. Case report: rapidly progressive metastatic pulmonary calcification: evolution of changes on CT. Br J Radiol 2009; 82 (980) e155-e159
    CrossrefPubMedGoogle Scholar
  • 41 Belém LC, Zanetti G, Souza Jr AS. et al. Metastatic pulmonary calcification: state-of-the-art review focused on imaging findings. Respir Med 2014; 108 (05) 668-676
    CrossrefPubMedGoogle Scholar
  • 42 Taguchi Y, Fuyuno G, Shioya S. et al. MR appearance of pulmonary metastatic calcification. J Comput Assist Tomogr 1996; 20 (01) 38-41
    CrossrefPubMedGoogle Scholar
  • 43 Justrabo E, Genin R, Rifle G. Pulmonary metastatic calcification with respiratory insufficiency in patients on maintenance haemodialysis. Thorax 1979; 34 (03) 384-388
    CrossrefPubMedGoogle Scholar
  • 44 Rosenthal DI, Chandler HL, Azizi F, Schneider PB. Uptake of bone imaging agents by diffuse pulmonary metastatic calcification. AJR Am J Roentgenol 1977; 129 (05) 871-874
    CrossrefPubMedGoogle Scholar
  • 45 Rendich R, Levy A, Cove A. Pulmonary manifestations of azotemia. AJR Am J Roentgenol 1941; 46: 802-808
    Google Scholar
  • 46 Doniach L. Uremic edema of the lungs. Am J Roentgenol Radium Ther 1947; 58 (05) 620-628
    PubMedGoogle Scholar
  • 47 Depass SW, Jacobson HG, Poppel MH, Stein J. Pulmonary congestion and edema in uremia. J Am Med Assoc 1956; 162 (01) 5-9
    CrossrefPubMedGoogle Scholar
  • 48 Borgstrom K-E, Ising U, Linder E, Lunderquist A. Experimental pulmonary edema. Acta Radiol 1960; 54 (02) 97-119
    CrossrefGoogle Scholar
  • 49 Henkin RI, Maxwell MH, Murray JF. Uremic pneumonitis. A clinical, physiological study. Ann Intern Med 1962; 57 (06) 1001-1008
    CrossrefPubMedGoogle Scholar
  • 50 Mukai H, Ming P, Lindholm B. et al. Lung dysfunction and mortality in patients with chronic kidney disease. Kidney Blood Press Res 2018; 43 (02) 522-535
    CrossrefPubMedGoogle Scholar
  • 51 Nidus BD, Matalon R, Cantacuzino D, Eisinger RP. Uremic pleuritis: a clinicopathological entity. N Engl J Med 1969; 281 (05) 255-256
    CrossrefPubMedGoogle Scholar
  • 52 Berger HW, Rammohan G, Neff MS, Buhain WJ. Uremic pleural effusion. A study in 14 patients on chronic dialysis. Ann Intern Med 1975; 82 (03) 362-364
    CrossrefPubMedGoogle Scholar
  • 53 Bakirci T, Sasak G, Ozturk S, Akcay S, Sezer S, Haberal M. Pleural effusion in long-term hemodialysis patients. Transplant Proc 2007; 39 (04) 889-891
    CrossrefPubMedGoogle Scholar
  • 54 Kumar S, Agarwal R, Bal A. et al. Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease. Indian J Med Res 2015; 141 (03) 308-314
    CrossrefPubMedGoogle Scholar
  • 55 Alpert MA, Ravenscraft MD. Pericardial involvement in end-stage renal disease. Am J Med Sci 2003; 325 (04) 228-236
    CrossrefPubMedGoogle Scholar
  • 56 Rudnick MR, Coyle JF, Beck LH, McCurdy DK. Acute massive hydrothorax complicating peritoneal dialysis, report of 2 cases and a review of the literature. Clin Nephrol 1979; 12 (01) 38-44
    PubMedGoogle Scholar
  • 57 Hollett MD, Marn CS, Ellis JH, Francis IR, Swartz RD. Complications of continuous ambulatory peritoneal dialysis: evaluation with CT peritoneography. AJR Am J Roentgenol 1992; 159 (05) 983-989
    CrossrefPubMedGoogle Scholar
  • 58 Prokesch RW, Schima W, Schober E, Vychytil A, Fabrizii V, Bader TR. Complications of continuous ambulatory peritoneal dialysis: findings on MR peritoneography. AJR Am J Roentgenol 2000; 174 (04) 987-991
    CrossrefPubMedGoogle Scholar
  • 59 Yavuz K, Erden A, Ateş K, Erden I. MR peritoneography in complications of continuous ambulatory peritoneal dialysis. Abdom Imaging 2005; 30 (03) 361-368
    CrossrefPubMedGoogle Scholar
  • 60 Green A, Logan M, Medawar W. et al. The management of hydrothorax in continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int 1990; 10 (04) 271-274
    CrossrefPubMedGoogle Scholar
  • 61 Schwab SJ. Hemodialysis-associated central vein stenosis and thrombosis: unresolved problems. Semin Dial 1989; 3 (02) 141-144
    CrossrefGoogle Scholar
  • 62 Hinke DH, Zandt-Stastny DA, Goodman LR, Quebbeman EJ, Krzywda EA, Andris DA. Pinch-off syndrome: a complication of implantable subclavian venous access devices. Radiology 1990; 177 (02) 353-356
    CrossrefPubMedGoogle Scholar
  • 63 Stewart GD, Jackson A, Beards SC. Azygos catheter placement as a cause of failure of dialysis. Clin Radiol 1993; 48 (05) 329-331
    CrossrefPubMedGoogle Scholar
  • 64 MacRae JM, Ahmed A, Johnson N, Levin A, Kiaii M. Central vein stenosis: a common problem in patients on hemodialysis. ASAIO J 2005; 51 (01) 77-81
    CrossrefPubMedGoogle Scholar
  • 65 Schwab SJ, Harrington JT, Singh A. et al. Vascular access for hemodialysis. Kidney Int 1999; 55 (05) 2078-2090
    CrossrefPubMedGoogle Scholar
  • 66 Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21 (19) 3665-3675
    CrossrefPubMedGoogle Scholar