Venous Thrombosis
Male, 51 year old on hemodialysis for 7 years due to secondary membranous glomerulopathy. Underwent gastric bypass surgery for morbid obesity. Parathyroidectomy for parathyroid adenoma a year ago.
Admitted to the hospital to perform living related donor kidney transplant. The donor was his HLA identical sister. Early in the post - operative evolves anuric. Echodoppler renal graft was within normal limits. Immunosuppressive treatment with prednisone, cyclosporine and aziatropine is administered. Three days later presented sudden abdominal pain associated with bloating. Echodoppler showed renal vein thrombosis treated with thrombectomy of the renal vein graft. Oliguria persists. Serial doppler flow control is adequate in the renal artery and vein. Renal scintigraphy depicted hilum vessels (white arrow) but abscense of perfusion in the parechyma (yellow arrows around the kidney mostly photopenic in the periphery). Biopsy of the graft demonstrated necrosis and congestion of the cortex in approximately 90% of the examined tissue. Massive cortical necrosis. The transplant was then extracted.
Kidney renography is an excelent procedure to assess the arterial and venous vessel patency, though the pattern of absence of flow in the graft and hypoactive organ cannot differentiate these conditions from each other (1).
In a series of 10 patients, Ramos et al., found that patients with bank
grafts, had acceptable renal function, except one of then who was treated
with transplantectomy due to a renal venous thrombosis, as the case presented
herein. This would be a bad prognosis sign.
References:
1 Etchebere, Elba, Ramos Celso Dario y Camargo, Edwaldo. Trasplante Renal.p: 425-433 en: Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.
2 Ramos E, Alonso JC, Durán C, Gómez I, Martínez S, Almoguera I, Bittiini A, Domínguez P, Pérez Vázquez JM. Graft viability of patients with renal transplantation from non heart beating donors. Rev Esp Med Nucl. 2005 Jan-Feb;24(1):32-7.