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Complications associated with the invasiveness of diagnostic procedures
Last reviewed: 23.04.2024
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Invasive diagnostic procedures are used in radiation diagnosis of kidney disease for several decades. Interventional radiology - the synthesis of radiation methods of diagnosis and therapeutic and diagnostic manipulation acquires increasing importance in nephrology. The main areas of its application are the diagnosis and treatment of renal artery stenosis, kidney biopsy.
The accumulated experience shows that the incidence of side effects during the invasive studies is high enough, and serious complications that lead to the death of patients are possible. Two main types of diagnostic manipulations are used: catheterization of renal pelvis (through the urinary tract or by percutaneous puncture) and catheterization of renal vessels. In the first case, there is damage to the epithelium of the urinary tract, 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 area of the kidneys can occur with the development of massive bleeding. Catheterization of vessels with intraluminal introduction of RCC can lead to their rupture, massive bleeding, thrombosis, destruction of unstable plaques and development of cholesterol embolism of the kidneys and other organs, arterial spasm. The risk of such complications in elderly patients with advanced atherosclerosis is especially high.
Despite reasonable grounds to avoid invasive diagnostic procedures, there are reasons to use them: a higher contrast quality when the contrast agent is directly injected into the renal artery than with its systemic appointment; a significant reduction in the dose of RCC and the risk of nephrotoxicity; diagnostic invasive procedures are combined with therapeutic (for example, percutaneous intraluminal angioplasty) and used to test their results. Thus, the use of invasive diagnostic procedures can, in spite of the risk of complications, ultimately positively influence the prognosis in some patients due to an increase in the accuracy of diagnosis and a reduction in the risk of nephrotoxicity of contrast.
The use of visualization methods of research requiring invasive procedures is justified only in cases when their results can significantly affect the therapeutic tactics (for example, to decide whether surgical treatment of renal artery stenosis is advisable) and improve the prognosis, and less invasive methods do not allow this or are not available.
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