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Registration Form Kidney Transplant Urology Department Transplant Center Clinic Bremen-Mitte - Registration Form Kidney Transplant

- 9/20/21 - 1 form, 6 itemgroups, 70 items, 2 languages
Itemgroups: Personal Information, Diagnosis, Therapy, Anamnesis, Clinical evaluation, Immunological data
Item used as routine documentation by Clinic Bremen-Mitte, Urology Department, Kidney transplant. ODM derived from form “Anmdeldebogen- NTx” Number TPLF006, Version 3, Transplant Center Bremen, Clinic Bremen-Mitte gGmbH 28177 Bremen. Investigations before registering for kidney transplant (Application with medical report and Epicrisis) 1. Obligatory examinations 1.1. Imaging techniques - Chest X-ray in two planes (Finding and image) - X- ray pelvis overview (without gonad protection in females) (Finding and image) - Abdominal ultrasonography (liver, gall bladder, kidney own, aorta) 1.2. Consultation and additional examinations - Ophthalmologist - Gynecologist - Dermatologist - Otolaryngologist - Dentist - Urologist: Uroflow (rest precipitation> 500 mL / d), residual urine, sediment, urine culture, Prostate palpation and PSA determination aged 30 and older - Cardiologist: ECG (Original / Copy) 1.3. Laboratory tests Blood count, electrolytes, urea, creatinine, uric acid, iPTH, inorg. Phosphate, alkaline phosphatase, GGT, ALT, AST, LDH, total Bilirubin, total Protein, fasting blood sugar level, basal C-peptide and HbA1c (In all diabetics), triglycerides, cholesterol, BSG, BM-Test Colon albumin (3x), 55 years and older colonoscopy (according to current guideline) 1.4. Virology - Hepatitis (HBsAg, HBcAK, HBsAK, HCV antibodies) - HIV (1 and 2), CMV, EBV, VZV 1.5. Hepatitis B vaccination (with antibody detection) 2. Selective indicated examinations 2.1. Imaging tests - Abdominal CT by cystic kidneys, tumors in the History, Analgesic nephropathy - Coronary angiography by cardiac risk, by diabetics - Arterial angiography by PAD, pelvic vascular sclerosis in pelvic x- ray - Colonoscopy / Colon contrast enema with diverticulosis - CT abdomen on spec diverticulitis - Voiding cystourethrogram (VCUG) at Pyelonephritis-, urinary tract infection or stone in the urinary tract , unclear etiology of renal insufficiency - Urethro cystoscopy, retrograde Urethrography left/ right and Bladder irrigation left/ right Analgesic nephropathy or hematuria - Kidney bladder overview by medical history of kidney stone 2.2. Other examinations - Echocardiography, exercise ECG by aged 50 and older and by all diabetics - Gastroscopy at ulcer anamnesis - Lung function tests only if indicated (all smokers) - Carotid Doppler by flow noise or cerebral circulatory disorder

AN MS MEDD Anamnese KU NTX University Hospital Muenster (UKM) Subform

- 11/30/16 - 1 form, 5 itemgroups, 125 items, 2 languages
Itemgroups: General information, Vegetative anamnesis and management of risk factors, Clinical examination, Sonography of transplanted kidney, Summary/Procedure
Hospital Routine Documentation Subform at the University Hospital Muenster. Original Form name: AN MS MEDD Anamnese KU NTX.

MS NTX Ambulanz Stammblatt - composer University Hospital Muenster (UKM)

- 10/5/16 - 1 form, 10 itemgroups, 31 items, 1 language
Itemgroups: Kidney Transplantation, Diagnosis, Surgery, Puncture, Study Participation Status, Family History, Social History, Comments, Nephrology Practice, Kidney Transplantation Information
Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: MS NTX Ambulanz Stammblatt - composer.

Examination Form Transplantation Nephrology Waiting List Office University Clinic Muenster - Examination Form Transplantation Nephrology

- 5/1/16 - 1 form, 12 itemgroups, 158 items, 1 language
Itemgroups: Personal Information, Immunological data, medical history family, Anamnesis, Renal history, Obligatory medical examinations, Medical Examination Optional, Laboratory, Tumor markers, Virus serology, Laboratory values urine, Laboratory tests optional
Item used as routine documentation by University Clinic Muenster, Waiting list office, Transplantation Nephrology, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany. ODM derived from original form “Befundbogen”.

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