Kidney workup

Because of the potential effect it may have on other body systems and the risk of toxicity, a baseline medical workup is de rigueur in every patient who is a candidate for lithium therapy. This workup includes laboratory tests aimed at evaluating kidney function, thyroid status, complete blood count, cardiac function, and so on. 

Possible renal toxicity has been reported in two men after the use of this compound. One volunteer who had received the agent Intravenously had red blood cells in his urine shortly after the completion of his test. Extensive workup failed to uncover ai definite kidney disease or lesion to account for the bleeding, which persisted intermittently for a year after exposure. Such a phenomenon had not been noted in any previous glycolate study. It may be related to a pre-existing abnormality that did not show up in routine screening No additional information is available on the second patient. Animal studies had suggested chat such bleeding could Indeed result from EA 3834, from BZ, and even from atropine. 

MR techniques like MR angiography and urography have an improved spatial and temporal resolution and are therefore increasingly used for the workup of the urinary tract and the kidneys. 

A patient with hematuria requires complete diagnostic workup of the kidney and the complete urinary tract to exclude calculi. The guidelines of the American Urological Association (AUA) suggest cytological analysis, analysis of the urine and cystoscopy as well as excretory urography (Grossfeld et al. 2001). 

Angiography is no longer performed in the diagnostic workup of renal masses and is reserved for therapeutic interventions only. The study should start with an abdominal aortogram to determine the number and location of arteries supplying the kidney and the tumor. Selective catheterization and angiography of each feeding artery is performed to assess... 

As the simple renal cyst is-unlike in the adult population-rather uncommon in pediatric cystic kidney disease, a thorough workup and follow-up of even incidental findings are compulsory. 

Contralateral VUR may be present in about 10%-20% of patients with multicystic dysplastic kidney (Fig. 11.29). VUR is also present in a significant number of other uropathies, i.e., horseshoe kidney, crossed fused kidney, UPJ, and UVJ obstruction. Therefore, in any anomaly of this type, a VCU should be advised for a complete workup (Atiyeh et al. 1992 Ring et al. 1993 Song et al. 1995 Avni et al. 1997 Cascio et al. 1999). 

The main advantage of an in utero diagnosis is to induce an optimized neonatal workup of the uropathy so that no supplementary damage will occur to the kidney (Elder 1992 Skari et al. 1998 WOODDARD 1993). 

For all other anomalies, especially multicystic dysplastic kidney, renal ectopia, or unilateral agenesis, the workup should also include US and eventually a VCU in order to detect ipsi- or contralateral VUR, which would require prophylactic chemotherapy (AxiYEHetal. 1993 Flack and Bellinger 1993 Selzman and Elder 1995 Ismaili et al. 2005). Also of interest is to search for associated genital anomalies on pelvic ultrasound (Table 13.5) (Riccabona et al. 2006). 

Fig.25.12a-c. Right renal fracture in a 15-year-old boy. Initial workup showed perirenal leak and two vascularized small fragments (a). Delayed DMSA scan (b) showed severely decreased uptake of the right kidney (b). Delayed MRI provided the same functional results as DMSA scan, plus excellent depiction of renal morphology (c) (Courtesy of S. Hanquinet)... 

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