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


  1. 4/24/16 4/24/16 -
  2. 9/20/21 9/20/21 -
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September 20, 2021


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

Registration Form Kidney Transplant

Personal Information
Transplant type
Kidney transplant
Histological confirmation
Type of dialysis
ml/24 h
Clinical evaluation
First BM Test Colon
Second BM Test Colon
Third BM Test Colon (55 years and older instead gets colonoscopy, according to the current guidline)
Palpation and auscultation carotid artery (right)
Palpation and auscultation carotid artery (left)
Palpation and auscultation femoral artery (right)
Palpation and auscultation femoral artery (left)
Palpation and auscultation popliteal artery (right)
Palpation and auscultation popliteal artery (left)
Palpation and auscultation tibial artery (right)
Palpation and auscultation tibial artery (left)
Palpation and auscultation dorsalis pedis artery (right)
Palpation and auscultation dorsalis pedis artery (left)
Immunological data
Red cell concentrate
Whole blood
Fresh frozen plasma FFP
Organ Transplantation
Antibodies known?
Indications for the existence of an autoimmune disease

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