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Creatinine and CT Contrast?

todd121's picture
todd121
Posts: 1425
Joined: Dec 2012

My current oncologist won't give me the constrast with my CTs. My creatinine is 1.6 to 1.7. He wants to see it below 1.5 or he won't risk it.

I recently visited another oncologist with many years experience treating kidney cancer patients, and he said he'd give me the contrast but he'd just hydrate me really well before I have it.

Who here has experience getting CT contrast with creatinine over 1.4 or GFR 46 or below? Any bad experiences? I'm just wondering how risky it is to have the contrast with my kidney function.

I've heard some say they get half a dose? If you answer, could you please tell me your creatinine or GFR in your story of your experience? I'd like to see it related to kidney function. Thank you.

By the way, I had a very odd reaction to the MRI contrast last week. My wounds from my lap adrenalectomy are still not healed because of the continuing allergic reaction to the surgical glue. They are still slightly inflamed. The MRI contrast caused them all to  turn bright red and swell. Anyone have a reaction to the MRI contrast?

Best,

Todd

 

sblairc's picture
sblairc
Posts: 586
Joined: Feb 2014

My husband was able to get his creatinine number to lower. He lost some weight and also hydrated a lot including through the night the week before his scans. 

I'm not sure if it was both of those things, one of those things,  time from nephrectomy (6 months to a 12 months), or all of the above but we were pleasantly suprised with his lower blood pressure and lower creatinine. 

There are people on here that have gotten contrast at 1.6 I think, but perhaps he is worried about your reaction causing additional problems to the CT contrast. 

hydrangea's picture
hydrangea
Posts: 32
Joined: Oct 2012

 

Hi Todd,

I am sorry to hear that you have this dilema confronting you. I just had my scans yesterday and after reading your posting it really hit home. I don't know if my experince will help you but I will share what I am going through.

I had several CT scans with contrast  prior to the fall of 2012 without any problems.  In September 2012 I had a severe allergic reaction after having the CT scans for chest/abdomen/pelvis with and without contrast.  When it came time for the next 6 month scan the urologist ordered an MRI w/ contrast saying it was safer for me.  I had an open MRI w/ contrast and no reaction.  The urologist used to order the scans and then copies were sent to my oncologist.  When the oncologist received the MRI results he said he would prefer CT scan w/ contrast as it showed a better picture.  He disagreed with my urologist and now my oncologist orders all CT scans  Since then when I receive CT scans w/ contrast every 6 months I take medications prior to the contrast. ( Diphenhydramine, famotidine and prednisone)  I have made it through 4 CT scans with contrast following the procedure of taking meds prior to and no problems up until last week.  I always try to drink as much water as I can days prior to the required blood tests and scans to remain hydrated.

My CT scans were scheduled for 3/31/15 so last week I went for the blood tests to tests for creatinine, BUN and GFR.  The day before the scheduled scan (3/30/15) I received a call from the hospital saying they would have to conduct the scans a little different this time.  They said the results of the blood tests were:  creatinine 1.1, BUN 21 and GFR of 53.  They require a GFR of over 60 to do the procedure the way they did previously for me.  They reported the my creatinine level was fine but the BUN was high and the GFR was low.

So yesterday when I went for my scans I drank the contrast every 15 minutes for the first hour; took the remainder of my meds and then they administered an iv w/ fluids to hydrate me prior to getting CT scans with contrast and no contrast for chest/abdomen/pelvis.  Note:  the contrast this time was mixed in a water container - all over times the contrast was in glass bottles already prepared and rather chalky tasting.  This time the contrast was easier to digest so I am wondering if they diluted the amount of contrast.  After the scans were completed they did another iv w/ fluids and continued to observe me for any signs of allergic reaction to the contrast.  I appeared to be just fine after a hour or so and they said I could go home.  Several hours after being home I began to vomit and unable to drink the water and keep it down.  I know what to look for an allergic reaction, hives, trouble breathing, swelling, etc. so today I am keeping a close watch.  Today I am able to drink water (lots) and keep it down but I do have a puffy face and some itching.  No trouble breathing so that is good! 

Now I play the waiting game for the results of these tests - my appt. w/ the oncologist isn't until April 8th.  I am surprised that he didn't contact me with the blood results but thankful that the hospital picked up on this low GFR level.  I always thought it was the creatinine level that determined if you could have contrast or not and my thinking was 1.1 was a good level.  Do you know what a BUN high level of 21 indicates?  Scanexity has set in big time!

If you look at my profile you can see my stage/grade and type of RCC.  I will never forget TexasWedge telling me that my type is pretty nasty.  I sure do miss his knowledge & keen insight.

Hoping I haven't sent too lengthy of a message and you find it helpful in some way.  I wish you the very best in continuing your battle w/ this nasty disease!

I hardly every post but continue to read each and every posting daily.

Take good care,

Diane

 

 

 

 

 

 

 

 

 

Srashedb
Posts: 482
Joined: Dec 2013

Todd: 

i have always been uncomfortable with my husband getting contrast because of the effect on the remaining kidney but the PA at the oncologist ignored my questions and kept ordering them.

in December, his creatinine hit 1.68 and the nephrologist said no contrast; the oncologist was fine with that and somehow the CT scans were read quite well. In fact, the radiologist picked up some lesions that received radiation.

he had scans two weeks ago, again without contrast (the creatinine was down to 1.52) and they were read well; the rib they had been watching had worsened and a spot of 7 mm was picked up on the L3 pedicle so we are meeting with the radiologist/oncologist to set up Cyberknife. 

We are told that the contrast used with MRIs is damaging to kidneys; this is an unusual reaction but when it happens, that is what gets affected. The contrast is called gaudalin (sp?) and the kidney impact can be serious. This can happen to anyone but obviously for those with kidney cancer, it is a much more serious effect.

try the CTs without contrast and see what is seen and not seen; it was remarkable to me that the oncologist had no problem going without and that it was only the PA who ordered it. The oncologist was not pleased that the contrast had been injected instead of given orally.

Sarah

Ree_Maryland's picture
Ree_Maryland
Posts: 157
Joined: May 2014

hi,

I go in for the yearly check up April 3rd , I can not have a CT WITH IODINE so had the CT wihout it , Iam alergic to it . So if the Dr. sees that I need it after all I will get it done in the hospital  when I go see him Friday or sometime when he think I need CT with Iodine . anyway my Bun was 20 my GFR IS 67 and the Creatine is 0.91, I had a R kindey RCC had to have it removed , LAPS. Last April 21st 2014 , I hope and pray it goes well , the tumor was PT1B  FRUMAN 1 size 5.8cm  Hope this makes sense,.  This club I am has been really helpful and not so scary , 

foxhd's picture
foxhd
Posts: 3183
Joined: Oct 2011

I guess my perspective is different. If people knew their life expectancy was only a year or two, what difference would contrast make? But no one wants to believe they won't be cured, so they want the conservative approach to their tests and treatments. The reality is that most of us won't be cured. We will have our lives extended, but probably not to full life expectancy. It is not going to be complications from x-rays or ct scans with and without contrast that kill us. Get reduced dosage of contrast, drink lots of water to flush it out, and know the radiologist will have a much better image to review. How else would you get the right treatments to fight your cancer if you do not identify as much of it as possible?

hydrangea's picture
hydrangea
Posts: 32
Joined: Oct 2012

 

Hi Fox,

I am pleased to see your response to the scan discussion.  I am also relieved to see any posting from you as I have followed your journey.  I know you are going through tough times now but your outlook always gives so much promise to all of us.  I can't agree more with you in regards to CT scans w/ contrast.  Even since my allergic reaction in 2012 I have had others question why I go through the risk of having them done w/ meds knowing I could have another allergic reaction.  It is because like you I know even if I have a bad reaction in the hospital, they will take care of me.  I want that radiologist to have a better image to view and my oncologist feels CT scans w/ contrast are the best way for the best images.  As you will see from my previous posting today I had my scans done yesterday but as I sit here tonight I am covered in hives from head to toe!  I am taking benadryl but not much relief yet.  Seems I get a delayed reaction after the scans. The hives didn't surface until late this morning, almost 20 hours after the scan.  I am not experiencing any difficulty breathing which did happen in 2012 so I am thankful for that.  I guess I will just be itch and scratch until the hives go away!  

You continue to be in my thoughts and prayers.

Diane

 

 

Ree_Maryland's picture
Ree_Maryland
Posts: 157
Joined: May 2014

I think I will def ask my Dr tomorrow about the CT with contrast . Just to be safe , thanks for the imput. My allergic reaction is swelling legs like rocks and itching and hives but hey I think I would feel better if Dr prescribes CTw/ contrast . thanks guys. 

 

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

I'm with Fox on this one. The time is passed for worrying about these kind of risks. Do what you can to mitigate any side effects( mainly drink a lot of water). But get the most information as you can from any examination.

NewDay's picture
NewDay
Posts: 273
Joined: May 2012

Todd,

The decision not to use contrast based on creatinine or eGFR has nothing to do with the possibility of an allergic reaction.  It is because a high creatinine or low eGFR indicate that your remaining kidney has some degree of kidney damage and the CT contrast can cause kidney failure.  Most doctors seem to look at creatinine to make the call, but some radiologists or imaging facilities make the decision based on eGFR.  eGFR (estimated glomerular rate)  is based on a calculation that uses creatinine, BUN, age, race,  and weight.  I have had the doctor order the CT with contrast and then the radiologist refuse to administer it.  Some facilities will allow contrast with an elevated creatinine, but administer fluids prior to the scan and, sometimes also after.  Some do not.  The contrast used for an MRI is supposed to carry less risk to the kidney, but, when I was at NIH/NCI, they refused to give me contrast with either one.  My creatinine at the time was 1.8.

Your creatinine can vary considerably even throughout the day.  My fluctuates between 1.3 and 1.8 depending on how dehydrated I am.  Try to be as hydrated as you can before your blood test and you may be able to bring it down.  Of course, also be as hydrated as you can before the CT scan.  Usually they will allow you to have constrast as long as it is not higher than around 1.4.

Even with a normal creatinine and eGFR, once you have an allergic reaction, some facilities will no longer allow it.  Others will just administer drugs and/or fluids.  They all have their own rules.

The advantage of getting contrast is that the scan more accurately shows the size and presence of tumors and shows them more clearly.  Scans without contrast are still useful, but may miss some very small tumors. It is always preferable to get IV contrast if possible, but the risk of kidney failure is too high if your kidney already is not functioning normally.  In weighing the risk and benefit, your doctor is considering that kidney failure can cause you to go on dialysis and can even take you out more quickly than the cancer. 

My understanding is that MRI’s are better than CT’s at highlighting bone tumors and brain tumors, but some people cannot have them because they have metal in their bodies from prior surgeries and have plates or pins.  An MRI cannot be done with these because they use high powered magnets.

Some doctors order chest xrays and abdominal ultrasounds.  Those are a bad idea as they can both definitely miss tumors and the images are not nearly as clear.  I had a radiologist not recognize my 9cm tumor on an ultrasound because of the quality of the image although a more competent radiologist would probably have caught it.

Oral contrast and IV contrast are two different things.  The oral contrast you drink highlights only your digestive tract and is not harmful to the kidneys.  It is unusual for it to cause an allergic reaction, but for some people it causes diarrhea.

I hope this information is useful to you and others.  I hope your scans go smoothly and show good results.

Kathy

 

 

 

todd121's picture
todd121
Posts: 1425
Joined: Dec 2012

Thanks Kathy. I did realize the injected CT contrast could cause kidney damage, but wasn't aware it could cause kidney failure. That would definitely make my situation worse.

My creatinine varies from 1.6-1.7, rarely in the 1.5 something range. My eGFR the last time I remember it was 46.

I had a mild allergic reaction to the MRI injected contrast last time. It was very weird. Only my incisions which are fresh from the laproscopy (and already inflamed from an allergic reaction to the glue) turned bright red and swelled. Very odd. They'd never seen that before.

The bad things about allergic reactions is they can get worse.

Sometimes you can get pre-treated with an injectable anti-histamine if you know you'll have an allergic reaction. Those of you with allergic reactions might inquire about getting pre-treated.

I've never had a problem with the oral contrast you drink before the CT scan.

Appreciate all the responses.

Todd

PK_Chicago
Posts: 58
Joined: Mar 2012

I've always been told that the "no contrast" in a CT was based on the ability to "filter" it out of your system - not the creatinine level.  It was always explained to me as a protection for my remaining kidney.  In an MRI and PET the dye is different and is not as toxic ot a single kidney patient. 

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