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Renal Angiogram

Renal arteriography is a special x-ray of the blood vessels of the kidneys. Renal arteriography is also called renal angiography.

Hospital Stay: Hospital Stay: 1 day
Duration: Duration: 1.5 hrs
Cost Estimate: Cost Estimate: 292 USD - 793 USD These are indicative prices in Indian Hospitals

The test is done to look at the blood vessels that feed the kidney. It may show:

  • Aneurysm (a widening of the vein or artery)
  • Abnormal connections between veins and arteries (fistulas)
  • Blood clots
  • Narrowing of the blood vessels of the kidneys (renal stenosis)
  • Benign noncancerous tumours and malignant cancerous tumours
  • Active bleeding from the kidney

Renal arteriography is often used to examine donors and recipients before a kidney transplant to determine the number of arteries and veins on each kidney. Many of the problems seen on the renal arteriogram, like aneurysm, and narrowing or bleeding of the kidney arteries can be treated when the arteriogram is done.

This test is done in the hospital. You will lie on an x-ray table. The health care provider will clean and shave an area of the body (most often near the groin). Numbing medicine will be applied to the area. A needle is then placed into the artery.
When the needle is in the proper position, a thin wire is passed through it into the artery. The needle is taken out, and a long, narrow, flexible tube called a catheter is put in its place.

The radiologist guides the catheter into the proper position with the help of x-ray images of the body. The images are made by an instrument called a fluoroscope and sent to a TV monitor that the doctor can see.

The catheter is pushed forward over the wire and into the aorta (the main blood vessel leading from the heart) and then into the kidney artery. The test uses a special dye (called contrast) to help the arteries show up on the x-ray. The blood vessels of the kidneys cannot be seen with ordinary x-rays. The dye flows through the catheter into the kidney artery.

X-ray images are taken as the dye moves through the blood vessels. Saline (sterile salt water) containing a blood thinner may also be sent through the catheter to keep blood in the area from clotting.

The catheter is removed after the x-rays are taken. A closure device is placed in the groin or pressure is applied to the area to stop the bleeding. The area is checked after 10 or 15 minutes and a bandage is applied. You may be asked to keep your leg straight for 4 to 6 hours after the procedure.

Preparation

Tell the health care provider if:

  • You are pregnant
  • You have ever had any bleeding problems
  • You currently take blood thinners, including daily aspirin
  • You ever had any allergic reactions, especially those related to x-ray contrast material or iodine substances
  • You have ever been diagnosed with kidney failure or poorly functioning kidneys You must sign a consent form. Do not eat or drink anything for 6 – 8 hours before the test. You will be given a hospital gown to wear and asked to remove all jewelry. You may be given a sedative or pain pill before the procedure.

Abnormal Results

Renal angiography may show the presence of tumours, narrowing of the artery or aneurysms (widening of the vein or artery), blood clots, fistulas, or bleeding in the kidney.

The test may also be done with the following conditions:

  • Acute arterial occlusion of the kidney
  • Atheroembolic renal disease
  • Renal artery stenosis
  • Renal cell carcinoma
  • Angiomyolipomas (noncancerous tumours of the kidney)

Risks

The procedure is generally safe. The may be some risks, such as:

  • Allergic reaction to the dye (contrast medium)
  • Arterial occlusion from dissection
  • Damage to the artery or artery wall, which can lead to blood clots
  • Kidney damage from damage to the artery or from the dye

There is low radiation exposure. Pregnant women and children are more sensitive to the risks related to x-rays.

Home instructions

Once at home, you should monitor the injection site for bleeding. A small bruise is normal, as is an occasional drop of blood at the site.

If the groin or arm was used, you should monitor the leg or arm for changes in temperature or color, pain, numbness, tingling, or loss of function of the limb.

Drink plenty of fluids to prevent dehydration and to help pass the contrast.

You may be advised not to do any strenuous activities or take a hot bath or shower for a period of time after the procedure.

Notify your doctor to report any of the following:

  • Fever and/or chills
  • Increased pain, redness, swelling, or bleeding or other drainage from the groin injection site
  • Coolness, numbness and/or tingling, or other changes in the affected extremity

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Two kidneys, a pair of purplish-brown organs, are located below the ribs toward the middle of the back. Their function is to:

  • Remove liquid waste from the blood in the form of urine
  • Keep a stable balance of salts and other substances in the blood
  • Produce erythropoietin, a hormone that aids the formation of red blood cell
  • Release calcitriol, the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
  • Regulate blood pressure

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.

Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.

An angiogram, also called an arteriogram, is an X-ray image of the blood vessels. It is performed to evaluate various vascular conditions, such as an aneurysm, stenosis or blockages.
A renal angiogram is an angiogram of the blood vessels of the kidneys. A renal angiogram may be used to assess the blood flow to the kidneys.
Fluoroscopy is often used during a renal arteriogram. Fluoroscopy is the study of moving body structures similar to an X-ray “movie.” A continuous X-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail.

In order to obtain an X-ray image of a blood vessel, an intravenous (IV) or intra-arterial (IA) access is necessary so that contrast, also known as X-ray dye, can be injected into the body’s circulatory system. This contrast dye causes the blood vessels to appear opaque on the X-ray image, thus allowing the physician to better visualize the structure of the vessel(s) under examination.

Many arteries can be examined by an angiogram, including the arterial systems of the legs, kidneys, brain, and heart.

For a renal angiogram, arterial access may be obtained through a large artery such as the femoral artery in the groin. Once access is obtained, the catheter is advanced to the renal artery, contrast is injected, and a series of X-ray pictures is made. These X-ray images show the arterial, venous, and capillary blood vessel structures and blood flow in the kidneys.

Other related procedures that may be used to diagnose kidney problems include kidney, ureters, and bladder (KUB) X-ray, computed tomography (CT scan) of the kidneys, intravenous pyelogram, kidney biopsy, kidney scan, kidney ultrasound, magnetic resonance imaging (MRI), and renal venogram. Please see these procedures for additional information.

A renal angiogram may be performed to detect abnormalities of the blood vessels of the kidneys. Such abnormalities may include, but are not limited to, the following:

  • Aneurysms
  • Stenosis or vasospasm (spasm of the blood vessel)
  • Arteriovenous malformation (an abnormal connection between the arteries and veins)
  • Thrombosis (a blood clot within a blood vessel) or occlusion (blockage of a blood vessel)
  • Renovascular hypertension (systemic high blood pressure caused when the renal artery is narrowed)

Other conditions that may be detected by a renal angiogram include tumours, hemorrhage (bleeding), complications of kidney transplantation, and the invasion of a tumour into the blood vessels. An angiogram may be used to deliver medications directly into the tissue or organ needing treatment, such as the administration of a clotting medication to a bleeding site or cancer medication into a tumour.

Renal angiograms are less frequently use with CT and MRI scans being more commonly used for diagnosing these conditions. Renal angiogram may also be recommended after a previous procedure, such as a CT scan, indicates the need for further information.

There may be other reasons for your doctor to recommend a renal angiogram.

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider. Radiation exposure during pregnancy may lead to birth defects.

There is a risk for allergic reaction to the contrast. Patients who are allergic to or sensitive to medications, contrast dye, or iodine should notify their doctor. Also, patients with kidney failure or other kidney problems should notify their doctor as contrast can worsen existing kidney disease.

Because the procedure involves the blood vessels and blood flow of the kidneys, there is a small risk for complications involving the kidneys. These complications may include, but are not limited to, the following:

  • Hemorrhage due to puncture of a blood vessel
  • Injury to nerves
  • Thrombus. A clot in the blood vessel
  • Hematoma. An area of swelling caused by a collection of blood
  • Infection
  • Transient kidney failure
  • Damage to artery or arterial wall, which can lead to blood clots

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Certain factors or conditions may interfere with the accuracy of a renal angiogram. These factors include, but are not limited to, the following:

  • Remaining contrast substances from recent contrast studies, such as a barium enema
  • Gas or stool in the intestines

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