Renal angiography today is one of the most popular diagnostic methods that applies to both adult and small patients. Its uniqueness lies in the fact that it allows you to determine the disease, pathology in the case when other methods can not give a definite answer. In particular, kidney angiography helps diagnose tumor processes, organ damage, abnormalities in its development, etc. We will answer all the most relevant questions about the procedure later in the article.
What is it?
Kidney angiography is a method of studying the arterial network using an X-ray unit and a contrast medium. The fact is that the circulatory system in the thickness of the kidneys is developed quite well, which makes such an examination possible. Angiography, in fact, studies the changes in its functioning.
Violations in the work of blood vessels that are detected during the procedure can talk about a general disorder of their functioning, the development of certain pathologies. Renal angiography also gives an idea of the anatomical and functional state of these organs.
What is the purpose of the procedure?
The procedure is prescribed by the doctor to the patient for the following purposes:
- To study the characteristics of the vascular system of an organ before surgery.
- To determine the cause of the development of renovascular hypertension.
- To assess the functioning of the vascular system in chronic diseases of the urinary system, renal failure.
- To detect neoplasms in the kidneys - both benign and malignant.
- For the diagnosis of certain complications that occur after kidney transplantation.
- For differentiation of cysts, tumor processes.
Renal vascular angiography is used to identify the above pathologies, diseases and disorders.
What are the indications for the procedure?
We analyze the following important question. What are the indications for kidney angiography? Here is the main list of them:
- Suspicion of the development of a tumor in the kidney. In particular, in its outer (or cortical) substance.
- Anomalies in the development of an organ of complex nature.
- Hypertensive disease, the etymology (causes) of which has not been elucidated.
- Tumors that develop in the adrenal glands and other organs located in the retroperitoneal region.
- It is impossible to apply other methods for diagnosing kidney disease. For example, retrograde pyelography. Also, a "kidney angiography" analysis is prescribed if excretory urography cannot demonstrate the type and severity of the progression of the disease.
- The patient was diagnosed with renal hematuria (detected blood in the urine), and the reasons for this are not elucidated by other diagnostic methods.
- In order to differential diagnosis of a tumor, kidney cysts.
- Hydronephrosis is established - an overflow of the kidney with liquid, which causes the expansion of the organ.
- Kidney tuberculosis was detected in a patient.
What are the absolute contraindications?
Contraindications to renal angiography are divided into two groups - absolute and relative. The first includes such factors that categorically prohibit the procedure:
- Inoperable condition of the patient.
- Individual intolerance of contrast medium.
What are the relative contraindications?
Relative contraindications to the diagnosis of "kidney angiography" are those factors that specialists should pay close attention to. However, they are not always the basis for a complete rejection of the procedure. The final decision is up to the attending doctor. He accepts it, based on the individual characteristics of the patient's body.
Relative contraindications include the following:
- Post-infarction condition.
- Pathologies of a cardiovascular nature that can lead to decompensation.
- Angina pectoris in severe form.
- Hypertension of the third stage (a condition characterized by noticeable changes in the structure of blood vessels).
- A number of diseases of the liver and kidneys.
- General exhaustion of the body.
- The age of the patient. In particular, with caution, angiography of the vessels of the kidneys is carried out in relation to young children, the elderly.
- Pregnancy at any time. A positive decision is made by the doctor in the case when the potential benefit for the woman is higher than the risk of complications in the unborn child.
- An allergy to iodine-containing drugs in the anamnesis (medical history).
- Severe renal failure.
- Severe atherosclerosis of the aorta or other vessels through which the puncture will be performed.
- Thyrotoxicosis, acute in the patient. This is the name of hyperthyroidism, which is accompanied by increased formation of hormones - up to and including poisoning of the body.
- Active pulmonary tuberculosis.
- Severe cardiovascular failure.
- Inflammatory processes in young patients.
How to prepare for the procedure?
To conduct angiography of the renal arteries, the patient must properly prepare:
- For two weeks, completely exclude alcohol-containing drinks from your diet.
- A week before the procedure, abandon blood thinners. In particular, they include a group of aspirins.
- 5 days before angiography, undergo the following examinations: electrocardiogram, ultrasound of the heart, fluorography.
- Also, for 5 days, the patient passes the following tests - a coagulogram (blood coagulation test), blood tests (general clinical, biochemical, blood type and Rh factor), hepatitis, HIV infection and syphilis.
- 2 days before angiography, a tolerance test of the contrast medium is performed. If allergic reactions, changes in cardiovascular activity are diagnosed, then this examination of the kidneys is canceled.
- For 1 day, the patient should remove the hair in the area that is determined by the attending physician.
- The night before the examination, you need to sleep well. If sleep does not occur, then it is not forbidden to take an antihistamine, sedative.
- In the morning before angiography, the patient cleanses the intestines. The procedure is carried out using an enema or special candles.
- The procedure is performed on an empty stomach - with the onset of the date on which the examination is scheduled, you should refuse food and drink.
- Empty the bladder immediately before angiography.
How is the examination carried out?
To date, kidney angiography is performed in two ways:
- Translumbar aortography. In this case, aortic puncture is performed in the patient’s lumbar region.
- Transfemoral aortography. Here, the contrast agent is introduced into the patient’s femoral artery.
This or that method in relation to a particular patient is directly selected by his attending physician.
After a translumbar examination, the patient is allowed to move around, get out of the hospital bed after 24 hours. But after transfemoral bed rest you need to observe longer - three days.
We will consider the nuances of each of the procedures below separately from each other.
How is transluminal aortography performed?
Let's take a step-by-step look at how this CT scan is performed - renal vascular angiography:
- 20 minutes before the main procedure, the patient is given an injection of morphine.
- Also, for 20 minutes, a person is administered a solution of omnopon.
- Next, the patient should lie on his stomach. He extends his left arm along the torso, and takes his right arm to the side. This is necessary for registration during the procedure of his pulse and blood pressure.
- The next stage is local anesthesia of the lumbar region, where the puncture needle will be inserted.
- The patient holds his breath - at this moment, a contrast agent is injected into the aorta through puncture.
- In the first minutes after its introduction, specialists make a nephrogram and an arteriogram.
- The ending is a venogram.
- The waiting phase is 5 minutes. At its end, after the first radiographs, an excretory urogram is removed.
- The next stage is the introduction of Heparin and Novocain along with contrast. The first acts against thrombosis in the vessels, the second - against their spasm.
How is transfemoral aortography performed?
Despite the fact that the patient's recovery after this examination takes two days longer, the method has an undeniable advantage - there is no need to suture the puncture site with a puncture needle.
Transfemoral angiography usually goes like this:
- The patient is asked to lie on his back.
- A person is given an injection of Novocain.
- A contrast agent is introduced.
- The first radiographs are taken - an arteriogram, a nephrogram, a venogram.
- After 5 minutes, an excretory urogram is made.
In the video that follows, you can familiarize yourself with other nuances of conducting such studies.
Recommendations of specialists to the patient after examination
For patients undergoing renal angiography, the following is recommended:
- Refuse water hygiene procedures for 12 hours after the examination.
- Drink plenty of clean drinking water. Why is this needed? Drinking will help to remove the injected medications from the body.
- Do not remove the bandage that is applied to the puncture site with a puncture needle during the day.
- Exclude any kind of physical activity within 2 days after renal angiography. It’s best, of course, to keep bed rest all this time.
- Do not smoke 24 hours after the examination.
- Refuse driving the vehicle for a day after the procedure.
- To spend at least a day after angiography in bed, lying down.
Are complications possible after examination?
Renal angiography is safe for a patient who has no contraindications to the procedure. However, as after any other examination related to vascular puncture, a number of complications may develop after it:
- Allergic reaction to contrast medium.
- Renal artery occlusion as a result of dissection. In other words, stratification of the vessel wall.
- Damage to intima or artery walls. This can cause the formation of blood clots - blood clots in its lumen.
But the dose of radiation that the patient receives as a result of the procedure is very small. Most clinics use modern technology. One of its main advantages is the ultra-low dose.
Renal angiography is a diagnostic method that helps determine a number of serious diseases of the urinary system, pathology and abnormalities in the development of the organ. Apply it in cases where other diagnostic methods are powerless.