Answer for BIR CoW 17 June 2018
Post renal transplant status- anastamotic site stenosis
Findings
Doppler findings: Intraparenchymal renal arterial branches show parvus tardus waveform. Possibility of renal artery stenosis. MR Findings: Severe attenuated flow noted in transplant renal artery, anastomotic site & right internal iliac artery distal to anastomotic site.
Discussion
Renal Artery Stenosis: Occurs usually in the first year after transplantation. The stenosis may be located before the anastomosis, at the anastomosis or after the anastomosis. Causes: before the anastomosis : atherosclerotic disease in the donor vessel at the anastomosis : secondary to vessel perfusion injury, faulty suture technique, or reaction to suture material after the anastomosis : rejection, turbulent flow from kidney malposition, or arterial twisting, kinking, or compression Approximately half of renal artery stenoses occur at the anastomosis, and end-to-end anastomoses have a threefold greater risk of stenosis than end-to-side anastomoses. Several clinical scenarios should prompt a search for stenosis: (a) severe hypertension refractory to medical therapy, (b) hypertension and the presence of an audible bruit over the graft, (c) hypertension associated with unexplained graft dysfunction MR angiography has the advantage of requiring either no contrast material or a gadolinium chelate that is not nephrotoxic. Management: Primary treatment - Percutaneous transluminal angioplasty with or without stent placement.
REFERENCES: Kocak T, Nane I, Ander H, Ziylan O, Oktar T,Ozsoy C. Urological and surgical complications in 362 consecutive living related donor kidney transplantations.Urol Int 2004; 72:252–256. Bennett LN, Voegeli DR, Crummy AB, McDermott JC, Jensen SR, Sollinger HW. Urologic complications following renal transplantation: role of interventional radiologic procedures. Radiology 1986; 160:531–536. Gogus C, Yaman O, Soygur T, Beduk Y, Gogus O. Urological complications in renal transplantation: long-term follow-up of the Woodruff ureteroneocystostomy procedure in 433 patients. Urol Int 2002; 69:99–101. Choyke PL, Becker JA, Zeissman HA. Imaging the transplanted kidney. In: Pollack HM, McClennan BL, Dyer RB, Kenney PJ, eds. Clinical urography. 2nd ed. Vol 3. Philadelphia, Pa: Saunders, 2000; 3091–3118.
Findings
Doppler findings: Intraparenchymal renal arterial branches show parvus tardus waveform. Possibility of renal artery stenosis. MR Findings: Severe attenuated flow noted in transplant renal artery, anastomotic site & right internal iliac artery distal to anastomotic site.
Discussion
Renal Artery Stenosis: Occurs usually in the first year after transplantation. The stenosis may be located before the anastomosis, at the anastomosis or after the anastomosis. Causes: before the anastomosis : atherosclerotic disease in the donor vessel at the anastomosis : secondary to vessel perfusion injury, faulty suture technique, or reaction to suture material after the anastomosis : rejection, turbulent flow from kidney malposition, or arterial twisting, kinking, or compression Approximately half of renal artery stenoses occur at the anastomosis, and end-to-end anastomoses have a threefold greater risk of stenosis than end-to-side anastomoses. Several clinical scenarios should prompt a search for stenosis: (a) severe hypertension refractory to medical therapy, (b) hypertension and the presence of an audible bruit over the graft, (c) hypertension associated with unexplained graft dysfunction MR angiography has the advantage of requiring either no contrast material or a gadolinium chelate that is not nephrotoxic. Management: Primary treatment - Percutaneous transluminal angioplasty with or without stent placement.
REFERENCES: Kocak T, Nane I, Ander H, Ziylan O, Oktar T,Ozsoy C. Urological and surgical complications in 362 consecutive living related donor kidney transplantations.Urol Int 2004; 72:252–256. Bennett LN, Voegeli DR, Crummy AB, McDermott JC, Jensen SR, Sollinger HW. Urologic complications following renal transplantation: role of interventional radiologic procedures. Radiology 1986; 160:531–536. Gogus C, Yaman O, Soygur T, Beduk Y, Gogus O. Urological complications in renal transplantation: long-term follow-up of the Woodruff ureteroneocystostomy procedure in 433 patients. Urol Int 2002; 69:99–101. Choyke PL, Becker JA, Zeissman HA. Imaging the transplanted kidney. In: Pollack HM, McClennan BL, Dyer RB, Kenney PJ, eds. Clinical urography. 2nd ed. Vol 3. Philadelphia, Pa: Saunders, 2000; 3091–3118.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!