The provided UK guideline excerpts do not specifically detail investigations recommended for monitoring renal involvement in patients with Tuberous Sclerosis Complex. However, general recommendations for monitoring renal involvement and chronic kidney disease (CKD) are outlined, which would be applicable if a patient with Tuberous Sclerosis Complex develops these conditions.
For monitoring CKD, the frequency of monitoring estimated glomerular filtration rate (eGFRcreatinine) and albumin creatinine ratio (ACR) should be agreed upon with the patient NICE NG203. These measurements help indicate the risk of adverse outcomes such as CKD progression, acute kidney injury, and cardiovascular events NICE NG203.
A renal ultrasound scan should be offered to adults with CKD who have accelerated progression of CKD, visible or persistent invisible haematuria, symptoms of urinary tract obstruction, a family history of polycystic kidney disease (if over 20), or a GFR of less than 30 ml/min/1.73 m2 (GFR category G4 or G5) NICE NG203. Renal imaging is also used to investigate symptoms that suggest upper urinary tract disease NICE CG148. It is important to note that renal scintigraphy should not be used for routine surveillance in people with neurogenic lower urinary tract dysfunction NICE CG148.
For babies and children with urinary tract infections (UTIs), specific imaging schedules are recommended depending on age and the nature of the UTI NICE NG224. For instance, ultrasound during acute infection is recommended for atypical or recurrent UTIs in babies and children NICE NG224. A dimercaptosuccinic acid (DMSA) scintigraphy scan may be used 4 to 6 months after an acute infection to detect renal parenchymal defects, particularly in cases of atypical or recurrent UTIs in babies and children NICE NG224. Micturating cystourethrogram (MCUG) may be considered in specific circumstances, such as in babies younger than 6 months with atypical or recurrent UTI, or if there is dilatation on ultrasound, poor urine flow, non-E. coli infection, or a family history of VUR NICE NG224.