European Journal of Radiology 46 (2003) 83 /84
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Editorial
End stage renal disease
A variety of disorders may cause renal impairment
and chronic renal failure. Diabetic nephropathy is the
most common cause of end-stage renal failure in adults
in developed countries followed in frequency by chronic
glomerulonephritis. Chronic interstitial nephritis, espe-
cially analgesic nephropathy can also lead to chronic
renal failure. Vascular diseases of the kidney, both at the
microvascular (hypertensive nephrosclerosis) or macro-
vascular level (ischemic renal disease) are increasingly
recognised as a cause of end-stage renal failure. Other
less frequent disease entities include autosomal domi-
nant polycystic kidney disease, renal amyloidosis and
human immunodeficiency nephropathy. Regardless of
etiology, end-stage renal disease is characterized by
complex pathophysiological and pathoanatomic
changes which affect different organ systems. The
spectrum of chronic renal disease is additionally com-
plicated by hemodyalisis, peritoneal dialysis, renal
transplantation and administration of different medica-
tions. Radiological diagnostic modalities play an im-
portant role in the diagnosis and follow-up of patients
with renal failure. The relevance of percutaneous mini-
mally invasive radiological interventional procedures
related to hemodyalisis and renal transplantation has
been increasing in recent years, and these procedures
have been replacing more aggressive surgical treatment.
I have chosen three topics from the plethora of different
radiological modalities used in chronic renal failure.
Butrović-Ponikvar and Višnar-Perovič describe the
role of ultrasonography, which has become the first, and
the only frequent, imaging modality required for the
diagnostic work-up of patients with chronic renal fail-
ure. Ultrasonography with Doppler measurements of
resistance index at the intrarenal-artery level is capable
of demonstrating parenchymal atrophy and decrease in
renal size due to damage at the microvascular level, in
addition to sclerosis and fibrosis which are common end
results in numerous etiologically different chronic renal
diseases. Although the exact diagnosis of causative
primary renal disease still requires renal biopsy, infor-
mation on quantity of renal parenchyma and peripheral
resistance based on ultrasonography has an important
prognostic value in predicting the development of renal
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doi:10.1016/S0720-048X(03)00071-8
failure and planning optimal and timely renal replace-
ment.
Jevtic reviews the radiological appearances of a wide
spectrum of bone and soft tissue abnormalities which
occur as a consequence of complex biochemical dis-
turbances of the calcium-phosphate metabolism in
chronic renal insufficiency, during hemodyalisis, perito-
neal dialysis and following renal transplantation. Due to
more sophisticated diagnostic methods and more effi-
cient treatment, the previous */typical radiographic
features of secondary hyperparathyroidism and osteo-
malacia/rickets */are now less frequently seen. The most
common radiological manifestations of renal osteody-
strophy include different features of aluminium intox-
ication, soft tissue calcification, and complications
related to long-term hemodyalisis and renal transplan-
tation. Radiological investigations play an important
role in the early diagnosis and follow-up of renal bone
disease. Although numerous important imaging mod-
alities have been introduced to clinical practice, plain
film radiography still remains the most widely per-
formed examination.
Šurlan and Popovic have written an overview of the
radiological interventional procedures available for the
treatment of numerous complications which may follow
hemodyalisis and renal transplantation. Over the past
two decades the long-term survival and quality of life of
patients with end-stage renal disease have improved due
to more efficient hemodyalisis and renal transplanta-
tion. Unfortunately both procedures may also be
associated with a considerable number of different
complications which require repeated surgical and/or
percutaneous radiological procedures. Ultrasonogra-
phy, MRI, CT, contrast radiographic and angiographic
studies may be indicated for the diagnosis of complica-
tions and the planning of interventional procedures.
Descriptions are given of a wide spectrum of percuta-
neous, and invasive procedures for endovascular man-
agement of complications associated with hemodialysis
fistulae and grafts, for treatment of perirenal fluid
collections, of vascular complications related to renal
transplantation and of relatively rare urological compli-
cations are minimally described.
84 Editorial / European Journal of Radiology 46 (2003) 83 /84

V. Jevtic
Department of Radiology,
Medical Faculty,
Zaloška 7,
SI-1525 Ljubljana,
Slovenia
E-mail address: vladimir.jevtic@mf.uni-lj.si