肾衰竭（KF）是指肾小球滤过率逐渐下降至每1.73平方米15毫升/分钟以下，需要进行透析或肾移植等肾脏替代治疗。 KF 的血流动力学和代谢改变与促炎和凝血状态相结合，导致复杂的多系统并发症。 KF全身表现的影像学特征是继发性甲状旁腺功能亢进引起的骨吸收。其他肌肉骨骼并发症包括棕色肿瘤、骨硬化、钙质沉着、软组织钙化和淀粉样关节炎。心血管并发症和感染是 KF 死亡的主要原因。心血管并发症包括加速动脉粥样硬化、心肌病、心包炎、心肌钙质沉着和静脉血栓栓塞。神经系统并发症如脑病、渗透性脱髓鞘、脑血管疾病和机会性感染也经常遇到。肺部并发症包括水肿和钙化。放射线检查和 CT 用于评估肌肉骨骼和胸部并发症，而 MRI 在评估神经系统和心血管并发症方面发挥着关键作用。 KF 患者通常避免使用 CT 碘造影剂，除非增强 CT 的益处大于风险以及已经接受维持性透析的患者。在 MRI 中，可以安全地将 II 族钆对比材料用于 KF 患者。作者讨论了 KF 的肾外全身表现、评估中影像学方式的选择以及并发症的影像学表现。 ©RSNA，2024 本文提供了补充材料。

Kidney failure (KF) refers to a progressive decline in glomerular filtration rate to below 15 ml/min per 1.73 m2, necessitating renal replacement therapy with dialysis or renal transplant. The hemodynamic and metabolic alterations in KF combined with a proinflammatory and coagulopathic state leads to complex multisystemic complications. The imaging hallmark of systemic manifestations of KF is bone resorption caused by secondary hyperparathyroidism. Other musculoskeletal complications include brown tumor, osteosclerosis, calcinosis, soft-tissue calcification, and amyloid arthropathy. Cardiovascular complications and infections are the leading causes of death in KF. Cardiovascular complications include accelerated atherosclerosis, cardiomyopathy, pericarditis, myocardial calcinosis, and venous thromboembolism. Neurologic complications such as encephalopathy, osmotic demyelination, cerebrovascular disease, and opportunistic infections are also frequently encountered. Pulmonary complications include edema and calcifications. Radiography and CT are used in assessing musculoskeletal and thoracic complications, while MRI plays a key role in assessing neurologic and cardiovascular complications. CT iodinated contrast material is generally avoided in patients with KF except in situations where the benefit of contrast-enhanced CT outweighs the risks and in patients already undergoing maintenance dialysis. At MRI, group II gadolinium-based contrast material can be safely administered in patients with KF. The authors discuss the extrarenal systemic manifestations of KF, the choice of imaging modality in their assessment, and imaging findings of complications. ©RSNA, 2024 Supplemental material is available for this article.