MRCP with Contrast for Someone with CKD

[choppedliver]

Our gastroenterologist (GI) is recommending that my aunt (72 years old) under go Magnetic resonance cholangiopancreatography (MRCP).  This is because a dilated common bile duct (size=1 cm) at the pancreatic head was discovered during an abdominal ultrascan.  The GI feels that the dilation could be due to either stones (gallstones), lesion, inflammation or strictures.  

I understand that MRCP is usually done using a contrast dye (gandolinium?).  Our nephro initially opposed the procedure but after seeing the ultrasound report, opted out by saying this is not his area.  Our PCP feels that we should wait until her GFR improves (her recent GFRs range from 27-31).  

Earlier, our GI recommended an ultrascan with contrast and this was also opposed by our nephrologist and GP.  It seems like we're trying to choose between two organs.  Can someone with GFR ~30 under MRCP?  The GI said that the procedure could be done using less contrast material, but I'm not reassured by this.  [Btw, this is the same GI that recommended a liver biopsy when I had fatty liver 10 years ago!  I mean, 1/3 of American have fatty liver!]

On the other hand, I don't want this CBD dilation to go unnoticed because it could be lesion and suggest cancer of the CBD or pancreas.  Has anyone undergone MRCP with comprosied kidneys?  

[Dr_Hacologist]

Dr_Hacologist
If CBD is dilated on the ultrasound and patient cannot have the contrast because of renal issue,  the ideal thing to do here would be endoscopic ultrasound that will give an idea about stones,  mass or structures in the CBD.  I dont know why your GI doctor has not thought about that.  Its a little invasive procedure but easily tolerated like endoscopy and will not affect the kidneys.

[Paderla Anitha, DNB]

Hello and hope you are doing well.

Understand your predicament. What about CT scan or MRI, this can pick up lesions in the pancreas without any contrast. Have you discussed this with your doctor.

Hope this helped and do keep us posted.

[Dr_Hacologist]

If CBD is dilated on the ultrasound and patient cannot have the contrast because of renal issue,  the ideal thing to do here would be endoscopic ultrasound that will give an idea about stones,  mass or structures in the CBD.  I don't know why your GI doctor has not thought about that.  It's a little invasive procedure but easily tolerated like endoscopy and will not affect the kidneys.

[choppedliver]

Hi, thanks for your comment.  No jaundice.  No fever.  Some nausea and she did vomit once but we thought that was because she started new hepatitis B medication, Baraclude, which could induce nause and vomitting.  She normally has elevated AST and ALT (50-60), due probably to chronic HBV.  Since February of this year, her Alkaline Phophatase started increasgin from about 175 to about 300 now.  I understand that this level of ALP could be due to CBD dilation.  Our GP and nephro don't seem that concerned with her very high ALP. Our GI is very concerned about her high ALP and want's MRCP done, in spite of her declining kidney function.

[Paderla Anitha, DNB]

Hello and hope you are doing well.

A deciding factor could be the clinical symptoms, if she has jaundice, nausea, vomiting, abdominal pain or fever, then you could opt for the procedure. Also, the liver function tests could be another marker to go by for the procedure.  

Hope this helped and do keep us posted.