Table 1. Laboratory, cardiovascular, pulmonary, imaging studies, and consultations required for kidney transplantation (KT) evaluation.
| Laboratory testing | |
|---|---|
| Metabolic panel | Serologies |
| Total and direct bilirubin Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Alkaline phosphatase Albumin and total protein Total cholesterol High-density lipoprotein (HDL) cholesterol Triglycerides, low-density lipoprotein (LDL) cholesterol Albumin Blood urea nitrogen Calcium Chloride Potassium Sodium Phosphorus Creatinine Glucose Bicarbonate Rheumatologic workup as indicated If patient has good pastures, order anti-glomerular basement membrane (GBM) antibody ABO blood group testing drawn on two separate occasions Human leukocyte antigen (HLA) typing Single antigen bead Troponin T Hemoglobin A1C C peptide (if diabetic) Thyroid-stimulating hormone (TSH) Parathyroid hormone (PTH) Pregnancy testing in females under 60 (unless they have had a hysterectomy) Serum protein electrophoresis (SPEP) with reflex for age > 50, history of Monoclonal gammopathy of undetermined significance (MGUS), myeloma, amyloid considered in patients with history of proteinuric kidney disease of unknown etiology |
For all patients Cytomegalovirus (immunoglobulin G [IgG] only) Herpes simplex virus ½ (IgG only) Varicella zoster virus (IgG only) Measles and rubella (IgG only) Ebstein–Barr virus (antibody profile—Epstein–Barr virus viral capsid antigen IgG/IgM and Epstein–Barr nuclear antigen) HIV ½ antibody Syphilis IgG HBsAb, HBs antigen, HBcAb Hepatitis C virus (HCV) antibody (Ab) HCV RNA if suspected to have recent HCV infection Hepatitis A virus (HAV)—total antibody For selected candidates (any candidate at risk for infection by virtue of residency or travel): Coccidioides immitis serology (EIA—enzyme immunoassay, ID—immunodiffusion, and CF—complement fixation) Strongyloides serology Schistosoma serology Trypanosoma cruzi serology Hematology Prothrombin time (PT)/international normalized ratio (INR) Complete blood count (CBC) with differential Urine tests Urinalysis Random urine protein and creatinine Gram stain (reflex urine culture) |
| Cardiovascular and pulmonary testing | |
| Electrocardiogram (EKG) Echocardiogram to evaluate valves and pulmonary pressures Stress test for patients with diabetes, age >59, prior coronary artery disease (CAD), or tobacco use Carotid duplex ultrasound for all patients with a history of CAD, stroke, transient ischemic attack (TIA), diabetes, or severe peripheral arterial disease (PAD) Thrombophilia workup: for history of lupus, clotting of access, miscarriages or prior clotting, consider thrombophilia clinic or order the following tests/thrombophilia profile | |
| Antithrombin activity plasma Cardiolipin (phospholipid) antibody Coagulation survey, lupus like anticoagulants Protein C activity Protein A free plasma Prothrombin G20210A nucleotide Beta 2 glycoprotein 1 antibodies (IgG, IgM, and IgA) | |
| Radiology imaging studies | |
| Chest X-ray posterior–anterior and lateral views Duplex scan of kidneys to evaluate for kidney size and presence of cysts Computed tomography (CT) of the abdomen/pelvis without contrast in patients who are older than 65 years of age or with diabetes mellitus (DM), PAD, and if they have been on hemodialysis or peritoneal dialysis for more than 3 years. If complex renal cysts are present, then abdominal CT with contrast should be done annually with urology evaluation Magnetic resonance angiography (MRA) of the brain without contrast should be obtained for all autosomal dominant polycystic kidney disease (ADPKD) patients, who have not had one completed | |
| Cancer screening | |
| Usual screening according to the American Cancer Society guidelines | |
| Consultations | |
| Transplant nephrology Transplant surgery Transplant nurse coordinator Transplant pharmacist Transplant nutrition Transplant financial coordinator Infectious diseases (if indicated) Psychology and psychiatry consultation (if indicated) Cardiology, if patient has history of cardiac problems or abnormal echocardiogram/stress test Other consultations and tests, as indicated | |