CT Scan contrast injection and kidneys, advice, please

[Ethel]

Hello!

I had advanced colorectal cancer in 2015 (radiation, operation, chemotherapy). Then the oncologist told me that I should do periodic CT Scans for five years, at first more frequently, then more far apart. So I’m now facing my one before last CT Scan.

However, the nephrologist worries about the cumulative effect of the contrast injection on the kidneys. He says that it can be like with chemotherapy and neuropathy, where for quite a while everything seemed fine, and then I got neuropathy which wouldn’t go away. He recommends getting IV fluids for an hour prior to the scan, then diluting the contrast injection with more IV fluids (also an hour) and then 6 hours of more saline IV fluids. However, the two nearby facilities I consulted don’t want to dilute the injection or offer fluids. They suggest going to the cancer center for pre-scan IV fluids, then to the CT scan facility for the test, then back to the cancer center for post-test fluids. That sounds exhausting to me, and the nephrologist still thinks that the contrast itself should be diluted, and that the radiologists don’t want the extra bother because it’s not them who’ll have to treat me if something happens to my kidneys.

The oncologist says that it’s OK to do brain MRI and chest CT without contrast, but not the abdominal CT – the image quality will be too compromised to be useful. (I don’t take the contrast drink for other reasons, but that doesn’t make a difference to image quality, according to the oncologist.)

I just don’t know what to do. On the one hand I know I need to do the abdominal CT Scan because cancer can reappear for up to five years. On the other hand I’m terrified of irrevocably damaging my kidneys.

I wonder if anybody here has faced this situation? Is there a way for people with kidney issues to do a CT Scan safely?

[csteven]

I have the same worry. After my post-surgery chemo (oxyplatinum) the kidney doctor said it damaged my kidneys. I'm at 41% filtration rate. I'm also supposed to do a CAT scan before my reversal surgery, but I'm scared to do further damage.

[mpbser]

Use supplements that 1) support kidney health and 2) chelate heavy metals.

[susie0915]

My oncologist always tells me to drink alot of water on the days before my scan, and my cancer center gives me a bottle of water for contrast before the scan, but does still do an IV contrast.

[Ron50]

After 21 years of survival with numerous scans and a heap of scopes done with fleet prep , my kidneys are toast. I suffer from nephrotic syndrome of the kidneys . I take cyclosporine twice a day. I have moderate to severe neuropathy of both feet and legs. I suffer auto immune oedema ( not related to nephrotic syndrome or congestive heart failure). I take lasik every day. my heart has been compromised by 5fu. I suffer around 11000 premature ectopic beats a day and have been dxed with atrial flutter and atrial fib. I take warfarin daily, Surviving survival is not easy. Ron.

[Ethel]

Thank you very much for your responses!

I have the same worry. After my post-surgery chemo (oxyplatinum) the kidney doctor said it damaged my kidneys. I'm at 41% filtration rate. I'm also supposed to do a CAT scan before my reversal surgery, but I'm scared to do further damage.

I'm so sorry to hear that. Did your doctors offer you any safer options to do the CT Scan, or there isn't any?

Use supplements that 1) support kidney health and 2) chelate heavy metals.

What kind of supplements? Are there side-effects? Is it something you take every day or just before a CT Scan? Has it proven effective for you?

My oncologist always tells me to drink a lot of water on the days before my scan, and my cancer center gives me a bottle of water for contrast before the scan, but does still do an IV contrast.

By "IV contrast" do you mean that they dilute the contrast injection with IV fluids where you have the CT scan done?

When I did my very first CT Scan, I was told to drink a lot of fluids afterwards, and I asked the nephrologist about it now, but he said that recent studies had shown that this really isn't very effective, and it has to be done intravenously. I understand that you drink a lot of fluids for several days before the scan - maybe it's more effective than just some afterwards? I do drink a lot of fluids every day anyway, though, because I have permanent ileostomy.

After 21 years of survival with numerous scans and a heap of scopes done with fleet prep , my kidneys are toast. I suffer from nephrotic syndrome of the kidneys . I take cyclosporine twice a day. I have moderate to severe neuropathy of both feet and legs. I suffer auto immune oedema ( not related to nephrotic syndrome or congestive heart failure). I take lasik every day. my heart has been compromised by 5fu. I suffer around 11000 premature ectopic beats a day and have been dxed with atrial flutter and atrial fib. I take warfarin daily, Surviving survival is not easy. Ron.

You can say that again! I know I should feel lucky to be alive, but I still don't want to get any more problems than I already have.

[MissMolly]

Ethel:
I would listen to your nephrologist and take to heart his recommendations for IV hydration.

Once an IV medication or IV contrast is administered there is no way to double-back and siphon out the infused medication or contrast.

Example: Once-a-year IV infusions of ReClast, an osteoporosis medication, are an available option. The dose is standardized, one-size-fits-all. It is recommended as an option for women who prefer NOT to take a monthly biophosphate medication as a pill nor Forteo as a monthly intramuscular epi-pen injection. There have been devastating cases of kidney failure associated with the singular/once a year ReClast infusion. Especially in women who are petite/lower body mass and with predisposing factors affecting kidney filtration.

I would listen to your nephrologist.
Karen

[erins]

I have Polycystic Kidney Disease, so my nephrologist has me drink lots of fluids beforehand, and does bloodwork about a week after a scan. My kidney function is normal right now, and I didn’t have to do chemo, so my overall kidney load hasn’t been bad. I do have to get IV contrast for my CT scans. Thus far they haven’t prescribed IV fluids, or diluted the IV contrast, but that remains an option on the table if there are any issues. Pre-contrast fluids were the most likely change for me, though it wasn’t prescribed for my latest scan.

For me, my nephrologist calls the shots on CT protocol—if they aren’t happy with my protocol or bloodwork, they can prescribe changes. I’d ask your nephrologist to order (in writing) the Iv fluids and diluted contrast—the radiologist may not be happy, but if it’s in writing from another doctor, there’s not much they can do. Also have your oncologist sign off, so that the radiologist has two other doctors to blame if their bosses get worked up.

Risk-wise, I was told that the risk of kidney damage was outweighed by the risk of undiscovered recurrence, especially since there were ways to minimize the kidney risk. It sounds like you and your nephrologist are on top of things, which is a big plus.

[mpbser]

I would follow the others' advice and listen to the nephrologist. He or she may be able to direct you towards particular supplements, if appropriate.

[jmn]

Glad to report that I have now completed 6 months of chemo (6,000 MG of capecitabine daily). In addition to my cancer diagnosis, I’m a diabetic who suffers from high blood pressure. While on chemo, I was referred by my MSK oncologist (Dr. Leonard Saltz) to a nephrologist (Dr. Insara Jaffer Sathick) because my kidneys were not functioning well. She ordered a number of tests, adjusted my medications, and continues to monitor my kidney problems closely. With her guidance, I was able to complete chemo without further damage to my kidneys. I just had my first post-chemo labs (CEA level is 3.4 mg/mL) and CT scan, and will soon undergo an abdominal/pelvic MRI without contrast at MSK, as both my nephrologist and oncologist are concerned that an MRI with contrast will do further damage to my already compromised kidneys. Unlike your doctor, they haven’t raised any concerns about image quality—though I’ll ask about it now that I’ve read your post.

[Ethel]

Thank you so much for your replies!

I would love to follow the nephrologist’s advice, but unfortunately in my hospital system it’s the radiologist who calls the shots on CT Scan procedure. The nephrologist told me that he can only make recommendations in writing, but the final decision is up to the radiologist, and he [the nephrologist] can’t make the radiologist do something other than what the radiologist wants to do. My problem is that it’s not part of the radiology’s procedure to offer IV fluids to anybody, and so they are not going to do it for me, regardless of what the nephrologist or the oncologist writes. I think this system is wrong, but I can’t force them to change it. That’s why I just don’t know what to do.

@mpbser
I’m sorry, I read in your signature, that you had a CT Scan in 5/18 which was clear, and then an MRI in 12/18 which showed one metastasis in the liver. Does it mean that a CT Scan is not as accurate as an MRI?

@jmn
My oncologist raised a concern about image quality in case of an abdominal CT Scan without contrast, not MRI. I’ll ask him about MRI. Did you do the CT Scan with contrast injection or without?

[WriterGirl1969]

Ethel - I'm really glad you started this topic. I'm particularly interested in the information as I've now developed an allergic reaction to the contrast dye as of this year's scan (never had this problem in the past). As part of that treatment, they asked me to push fluids as hard as I possibly could, but even drinking a ton I noticed a marked reduction in my urine output. I attributed that to the allergy meds, but now I believe that was not the cause. I've had some recent notes about protein in my urine, and the doctor asked if I had any symptoms of a UTI, but I did not. Figured this was part of being pre-diabetic. Again - now I'm thinking something completely different. I'll have to handle future scans differently now due to the allergy, and they may opt to not use the contrast at all, but I will definitely be keeping an eye on this information and on my urine labs.

As for whether or not your hospital system will allow for fluids, I have very strong feelings about this. You, the patient, should have the ultimate choice. It's your life and your body, after all. However, I totally get it that not everyone has options in medical care. If you have the option to try another facility, perhaps that's worth considering. If not, I would assume hydrating yourself well before and after is a good thing to do. I know I'll certainly be taking some additional precautions going forward.

Keep us posted.
Tracy

[natelaugh]

@Ethel,

My dad has chronic kidney disease. We had to get a CT scan with contrast and because his creatinine was at 35, the hospital had to give him IV fluid. After the IV fluid, his creatinine went up to 42, which is okay to do the scan. Maybe the radiologist think your creatinine meet the standard value. Also, you can drink more water afterward to flush the contrast out.

Nate.

[jmn]

@jmn
My oncologist raised a concern about image quality in case of an abdominal CT Scan without contrast, not MRI. I’ll ask him about MRI. Did you do the CT Scan with contrast injection or without?

Sorry for my delayed response, Ethel. I just now saw your question.

They did the CT scan without contrast. For what it's worth, the radiologist concluded there is "no metastases in the chest" but noted in the report that "lack of intravenous contrast limits evaluation."