Mandatory medical device diagnostics.
- Renal ultrasonography (ultrasound examination of the kidneys) – primarily to determine the size/shape of the kidneys.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Duplex sonography (ultrasound examination: combination of a sonographic cross-sectional image (B-scan) and the Doppler sonography method; medical imaging method that can dynamically visualize fluid flows (especially blood flow)) of the kidneys – for evaluation of the renal vessels, for example, in cases of suspected renal artery stenosis (renal artery narrowing)
- Renal scintigraphy – for the assessment of renal function.
- Magnetic resonance angiography (MRA) or CT angiography (CTA) – to assess the renal vessels, for example, if renal artery stenosis is suspected.
- Micturition cystourethrography (urological examination method in which the urinary bladder and urethra before and during micturition (urination) are depicted with the aid of contrast medium as part of an X-ray examination) – to exclude reflux (urine flowing back) as the cause of renal insufficiency.
- Renal biopsy (tissue sampling from the kidney) – for definitive diagnosis, treatment planning, prognosis assessment.
Note
- In patients with more severely impaired renal function (CKD stages 4 and 5, i.e., GFR < 30 ml/min/1.73 m2), the diagnostic benefit of radiographic/MRI contrast administration with potential reduction in morbidity and mortality should be given greater consideration over potential risks.
- A study on contrast administration and renal damage with a control group was able to show that patients after contrast administration were no more likely to suffer from renal damage than patients who had the same procedures or examinations without contrast. Conclusion: the acute deterioration of renal function is either due to the procedure, or it has occurred due to the patient’s disease.
- Renal protection in high-risk patients (impaired renal function or diabetes mellitus): use the lowest possible volume of contrast agent; before the examination, discontinue renal non-steroidal anti-inflammatory drugs (NSAIDs) and the antidiabetic drug metformin 24 hours before the X-ray examination.