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Complications associated with the invasiveness of diagnostic procedures
Last reviewed: 06.07.2025
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Invasive diagnostic procedures have been used in radiation diagnostics of kidney diseases for several decades. Interventional radiology - a synthesis of radiation diagnostic methods and therapeutic and diagnostic manipulations - is becoming increasingly important in nephrology. The main areas of its application are diagnostics and treatment of renal artery stenosis, and kidney biopsy.
Accumulated experience shows that the frequency of side effects in invasive studies is quite high, and severe complications are possible, leading to the death of patients. Two main types of diagnostic manipulations are used: catheterization of the renal pelvis (through the urinary tract or by percutaneous puncture) and catheterization of the renal vessels. In the first case, damage to the epithelium of the urinary tract occurs, there is a risk of rupture of the ureter, retrograde infection of the renal pelvis. With percutaneous puncture of the renal pelvis, damage to large vessels in the region of the renal hilum with the development of massive bleeding is possible. Catheterization of vessels with intraluminal introduction of RCS can lead to their rupture, massive bleeding, thrombosis, destruction of unstable plaques and the development of cholesterol embolism of the kidneys and other organs, arterial spasm. The risk of such complications is especially high in elderly patients with widespread atherosclerosis.
Despite the rationale for avoiding invasive diagnostic procedures, there are arguments in favor of their use: higher quality of contrast enhancement with direct administration of contrast agent into the renal artery than with its systemic administration; significant reduction in the dose of RCS and the risk of nephrotoxicity; diagnostic invasive procedures are combined with therapeutic ones (e.g., percutaneous intraluminal angioplasty) and are used to verify their results. Thus, the use of invasive diagnostic procedures, despite the risk of complications, may ultimately have a positive effect on the prognosis in some patients due to increased diagnostic accuracy and a reduced risk of contrast nephrotoxicity.
The use of imaging methods that require invasive procedures is justified only in cases where their results can significantly influence treatment tactics (for example, decide on the advisability of surgical treatment of renal artery stenosis) and improve the prognosis, and less invasive methods do not allow this to be done or are unavailable.
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