The pattern of modern medical care:
\u2022The patient gets sick and presents with a set of symptoms.
\u2022The physician determines a differential of possible diagnosis
\u2022The physician orders and performs a a slate of diagnostic studies: laboratory, physical exam maneuvers, imaging

A common calculation in determining the treatment is to weigh the risks of the inherent in the therapy and compare
them to the risks of the disease itself. The more severe the disease the more toxicity we are wiling to accept in the
therapy. The contemporary hospitalized patients are so ill that physicians routinely order therapies with huge de-
grees of associated morbidity: bypass surgery, chemotherapy, liver transplantation, radiation therapy; there is nearly
no limit to the amount of risk we will take to battle disease.

The bene\ufb01t that patients receive from undergoing a diagnostic tests are more dif\ufb01cult to pin-down than the bene\ufb01t from treatment. What bene\ufb01t does a patient gain from accurately diagnosing a self-limited, spontaneously resolving condition like post-strep GN? On the end of the scale, what bene\ufb01t does a patient gain from accurately diagnosing a fatal and untreatable condition like metastatic pancreatic cancer? Obviously patients have little gain from these pro- cedures and hence we should accept very little risk in the diagnostic work-up of these conditions.

There are three different diagnostic situations where renal issues \ufb01gure prominently in this determination of risk ver- sus bene\ufb01t: the risk of contrast nephropathy with iodinated contrast agents; the risk of nephrogenic systemic sclerosis with gadolinium containing paramagnetics for MRI/MRA ; and the risk of acute renal failure with sodium phosphate for bowel prep prior to colonoscopy.