肾功能衰竭患者的影像学检查方法不断发展。 过度强调碘造影剂诱发的急性肾损伤风险以及新的钆基造影剂管理指南影响了筛查和对比剂的选择。 肾衰竭的治疗需要透析或肾移植。 移植前的影像学评估包括评估进行移植的可行性以及评估基础恶性肿瘤和周围血管疾病。 肾衰竭患者患上肾细胞癌的风险较高。 肾功能衰竭患者独有或更常见的亚型，如社会获得性肾囊肿病、肾细胞癌和清细胞乳头状肾细胞癌，具有特定的临床病理特征和温和行为。进行透析规划的超声检查可以增加动静脉瘘成功放置的成功率，而术后超声评估在评估通路功能障碍方面至关重要。 肾功能衰竭患者的全身症状是多因素性的，可能与肾衰竭的根本原因有关，也可能是由于治疗效应而产生的。 慢性肾病和矿物骨疾病患者可见矿物质和骨代谢紊乱以及软组织和血管钙化。 神经和心肺并发症也很常见。 作者全面总结了肾功能衰竭患者的影像学考虑事项，包括正确使用CT，MRI和超声及其各自的对比剂； 影像学在移植工作和透析评估中的使用； 以及肾功能衰竭的常见肾脏和肾外表现。©RSNA，2023年 此文章的测验问题可在补充资料中找到。

The approach to imaging a patient with kidney failure continues to evolve. Overstatement of the risk of iodinated contrast material-induced (ie, contrast-induced) acute kidney injury and new guidelines for administration of gadolinium-based contrast media affect screening and the choice of contrast material. Treatment of kidney failure requires dialysis or a kidney transplant. Pretransplant imaging includes assessment for the feasibility of performing a transplant and evaluation for underlying malignancy and peripheral vascular disease. Patients with kidney failure are at high risk for renal cell carcinoma. Subtypes that occur exclusively or more commonly in patients with kidney failure, such as acquired cystic kidney disease, renal cell carcinoma, and clear cell papillary renal cell carcinoma, have specific clinical-pathologic characteristics, with indolent behavior. Performing US for dialysis planning increases the success of placement of an arteriovenous fistula, while postoperative US evaluation is essential in assessment of access dysfunction. Systemic manifestations in patients with kidney failure are multifactorial and may relate to the underlying cause of renal failure or may be secondary to treatment effects. Disturbances in mineral and bone metabolism and soft-tissue and vascular calcifications are seen in patients with chronic kidney disease and mineral bone disorder. Neurologic and cardiothoracic complications are also common. The authors provide a comprehensive overview of imaging considerations for patients with kidney failure, including the appropriate use of CT, MRI, and US with their respective contrast agents; the use of imaging in transplant workup and dialysis assessment; and the common renal and extrarenal manifestations of kidney failure. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.