Dear Sir/ Madam Thanks for your query. 1. It is not absolutely mandatory to undergo angiogram to detect ischemia. There are other methods too. These include stress ECHO and Stress thalium tests (Nuclear MPI scan). If your stress tests comes out to be positive and you are really symptomatic, you need to get an angiogram done. However the angiogram should only be done if you want to get the lesions (which will be diagnosed eventually) fixed by stenting or bypass. Second important this is that patients with kidney disease have 7 to 10 times higher risk of complications during angiogram/stenting/ bypass surgery. Your Cardiologist will also consider all these things to whom you must consult. Hope this provide some insight. Sincerely Sukhivnder