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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

Dialysis patient master sheet University Hospital Muenster (UKM) - Dialysis patient master sheet

- 10/4/16 - 1 form, 2 itemgroups, 22 items, 2 languages
Itemgroups: Demographic Information, Medical information
Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: Dialysestammblatt

Eligibility DRKS00006414 NCT00717366 Anemia - Eligibility

- 12/9/13 - 1 form, 2 itemgroups, 8 items, 2 languages
Itemgroups: Inclusion Criteria, Exclusion Criteria
ODM derived from http://clinicaltrials.gov/show/NCT00717366

AF MS Dialyseanmeld LSTM University Hospital Muenster (UKM) Subform

- 11/6/16 - 1 form, 1 itemgroup, 10 items, 2 languages
Itemgroup: dialysis admission
Hospital Routine Documentation Subform at the University Hospital Muenster

Dialyseprotokoll MEDD MS University Hospital Muenster (UKM)

- 12/6/16 - 1 form, 7 itemgroups, 52 items, 1 language
Itemgroups: General information, Monitoring, Parameters, Concentrate, Medication, Checklist, Comments
Hospital Routine Documentation Form at the University Hospital Muenster. Original Form name: Dialyseprotokoll MEDD MS

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