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Eskildsen DE, Guccione J, Menias CO, Shaaban AM, Morani AC, Shehata MA, Fagan RJ, Singer ED, Abdelaal MA, Jensen CT, Elsayes KM. Perirenal lymphatics: anatomy, pathophysiology, and imaging spectrum of diseases. Abdom Radiol (NY) 2023; 48:2615-2627. [PMID: 37269362 DOI: 10.1007/s00261-023-03948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite being rarely discussed, perinephric lymphatics are involved in many pathological and benign processes. The lymphatic system in the kidneys has a harmonious dynamic with ureteral and venous outflow, which can result in pathology when this dynamic is disturbed. Although limited by the small size of lymphatics, multiple established and emerging imaging techniques are available to visualize perinephric lymphatics. Manifestations of perirenal pathology may be in the form of dilation of perirenal lymphatics, as with peripelvic cysts and lymphangiectasia. Lymphatic collections may also occur, either congenital or as a sequela of renal surgery or transplantation. The perirenal lymphatics are also intimately involved in lymphoproliferative disorders, such as lymphoma as well as the malignant spread of disease. Although these pathologic entities often have overlapping imaging features, some have distinguishing characteristics that can suggest the diagnosis when paired with the clinical history.
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Affiliation(s)
- Dane E Eskildsen
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Akram M Shaaban
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mostafa A Shehata
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard J Fagan
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Emad D Singer
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Moamen A Abdelaal
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Deneault-Marchand A, Cohade C, Lamarche C. Fluid Collection after Kidney Transplantation. KIDNEY360 2022; 3:1291-1292. [PMID: 35919536 PMCID: PMC9337908 DOI: 10.34067/kid.0001762022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | - Christian Cohade
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont, Montreal, Canada
| | - Caroline Lamarche
- Department of Medicine, Université de Montréal, Montreal, Canada,Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Division of Nephrology, Department of Medicine, Université de Montréal, Montréal, Canada
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3
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Gamma camera imaging of renal transplant. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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4
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Amir N, Taher A, Thomas G, Shun A, Durkan A. Complications of surgical mesh patches after kidney transplantation in children-A case series. Pediatr Transplant 2021; 25:e13935. [PMID: 33280211 DOI: 10.1111/petr.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Abdominal compartment syndrome after kidney transplantation in pediatric recipients is a recognized complication relating to size discrepancy requiring abdominal wall closure over a large adult allograft. In order to circumvent this problem, our center implemented use of a surgical mesh, Surgisis® (Cook Surgical, Bloomington, IN), for abdominal wall closure in very small children to increase the surface covering over the organ and prevent compression. In this article, we report on the complications encountered following the use of these mesh patches. METHODS A retrospective case review was conducted of all pediatric kidney transplants from September 2006 to December 2018 and divided into abdominal wall closure with and without implantation of Surgisis® mesh patch. Review of clinical notes was performed to identify information with respect to clinical course and post-operative outcomes. RESULTS A surgical mesh patch was used in 7 pediatric recipients, of which 5 (71%) presented with post-operative complications. Three recipients were found to have bowel obstruction related to the surgical patch, necessitating bowel resection in one child. In addition, three children developed large serous fluid collections between the subcutaneous layers and the surgical mesh, requiring surgical drainage in two. CONCLUSIONS In view of these findings, we recommend close surveillance for potential complications in this cohort. Future research is needed to explore the safety of different approaches to achieve abdominal wall closure in this group.
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Affiliation(s)
- Noa Amir
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Amir Taher
- The Children's Hospital at Westmead, Westmead, NSW, Australia.,The University of New England, Sydney, Australia
| | - Gordon Thomas
- The Children's Hospital at Westmead, Westmead, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Albert Shun
- The Children's Hospital at Westmead, Westmead, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Anne Durkan
- The Children's Hospital at Westmead, Westmead, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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Bădulescu MR, Socaciu MA, Moisoiu T, Andries A, Iacob G, Badea R. Current status of imaging diagnosis in the transplanted kidney. A review of the literature with a special focus on contrast-enhanced ultrasonography. Med Pharm Rep 2020; 93:133-144. [PMID: 32478319 PMCID: PMC7243885 DOI: 10.15386/mpr-1536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Ultrasonographic scanning is currently the most widespread imaging diagnostic procedure. The method provides real-time morphological, vascular and elastographic information in a non-invasive manner. In recent years, harmonic vascular examination has become accessible using intravenous contrast agents. In urological pathology, this procedure is used in the detection and evaluation of vascular and ischemic complications, in the classification of complex cysts according to the Bosniak system, also in the renal lesions with uncertain etiology and in acute pyelonephritis for the detection of abscesses. The contrast agent (SonoVue) is angiospecific and can be used in patients transplanted immediately after surgery without adverse effects or impaired renal function. Thus, it is desirable to be used in the nephrological pathology of the renal graft and to develop diagnostic models based on the evaluation of renal microvascularization, as well as the quantitative data resulting from the graphical representation of the specific parameters. The purpose of this review is to evaluate the current state of the literature regarding the place and role of contrast substance ultrasound in the early diagnosis of acute renal graft dysfunction and to make a differential diagnosis of this pathological entity. Method This review quantifies the role of contrast ultrasound in the diagnosis of acute complications of the renal graft. The research was conducted based on the databases PubMed, MedScape, Cochrane, according to the search criteria such as contrast-enhanced ultrasound + kidney transplant, “time intensity curves” + “kidney transplant”, filtered for the period 2004–2018. Results In the nephrological pathology of the renal graft, contrast-enhanced ultrasound is a valuable tool, superior to Doppler ultrasound in predicting the evolution of the renal graft, identifying very small early defects in renal microvascularization. A number of studies succeeded in identifying acute graft dysfunction, some of which establish its etiology - humoral rejection versus acute tubular necrosis. On the other hand, the contrast-enhanced ultrasound parameters do not have the ability to distinguish between cellular and humoral rejection. Conclusions If, at present, the histopathological examination is the only one that can differentiate with certainty the cause of acute renal graft dysfunction, we consider that contrast-enhanced ultrasound, as a non-invasive imaging technique, opens a favorable perspective for increasing the survival of the renal graft and decreasing the complications in the renal transplant. The combination of other ultrasound techniques, together with contrast-enhanced ultrasound, could lead to the development of new diagnostic models.
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Affiliation(s)
- Maria Ramona Bădulescu
- Hemodialysis Department, 5 Medical Clinic and Urology Department. Clinical Institute of Urology and Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Adrian Socaciu
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Urology Department, Clinical Institute of Urology and Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra Andries
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medical Imaging Department, "Prof dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Gheorghiţă Iacob
- Morphology Department, Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca. Romania
| | - Radu Badea
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Powell R, Edney N, Aroori S, Connor A. Delayed Presentation of Urinoma Following Renal Transplant Biopsy: A Case Report. Transplant Proc 2020; 52:619-621. [PMID: 32143757 DOI: 10.1016/j.transproceed.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/26/2019] [Indexed: 11/27/2022]
Abstract
A urinoma is an unusual complication following renal transplant biopsy that can easily be missed or mistaken for a hematoma. In addition to trauma to the renal collecting system, a degree of urinary tract obstruction is required for urine to leak into the surrounding tissues and form a urinoma, which can in turn cause pressure on surrounding structures. This case report describes a patient who developed ipsilateral leg swelling several months after a renal transplant biopsy. Imaging demonstrated a perirenal transplant fluid collection, which biochemical analysis confirmed to be urine. This was successfully managed with percutaneous nephrostomy and antegrade ureteric stent insertion. The fluid collection persisted as a seroma however, and the patient proceeded to have peritoneal fenestration and marsupialization surgery. To our knowledge, this is the first reported case of urinoma complicating a renal transplant biopsy. This case highlights a diagnosis that can be easily missed and is therefore a potential pitfall for clinicians.
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Affiliation(s)
- Richard Powell
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, United Kingdom.
| | - Naomi Edney
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, United Kingdom
| | - Somaiah Aroori
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, United Kingdom
| | - Andrew Connor
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, United Kingdom
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8
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Intra-abdominal Complications After Pediatric Kidney Transplantation: Incidence and Risk Factors. Transplantation 2019; 103:1234-1239. [DOI: 10.1097/tp.0000000000002420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Kuczyńska M, Piasek E, Światłowski Ł, Kuklik E, Sobstyl J, Drelich-Zbroja A, Słomka T, Pyra K, Furmaga O, Szczerbo-Trojanowska M. Sonographic assessment of the prevalence and evolution of fluid collections as a complication of kidney transplantation. J Ultrason 2018; 18:126-132. [PMID: 30335921 PMCID: PMC6440513 DOI: 10.15557/jou.2018.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/22/2022] Open
Abstract
AIM OF THE STUDY The aim of this study is to assess the prevalence and evolution of perirenal fluid collections in a group of 488 patients who have undergone kidney transplantation. MATERIAL AND METHODS Sonographic documentation of 488 deceased-donor kidney recipients was evaluated for the prevalence of perirenal fluid collections and their evolution in time, depending on selected demographic features of the patients, time of detection, initial dimensions and precise position of the collection relative to the kidney and the location of the transplanted organ in the right or left iliac fossa. The collected data were used for statistical analysis to determine the strength of the potential relationships. RESULTS In 146 out of 488 subjects perirenal fluid collections were found. In 1/3 of the patients more than one fluid collection was diagnosed. Over 40% of fluid collections were detected within 10 days from the date of the first scan and 24.11% were detected within 10-20 days from the date of the first scan. The majority of fluid collections were located near the lower pole of the kidney. Perihilar collections were the least common. Collections encapsulating the kidney and subcutaneous collections were the largest in size on average. A statistically significant difference between the size of collections located on the surface and the size of those located near the upper pole of the transplanted kidney was demonstrated. However, no correlation was proven to exist between the persistence of the fluid collection and its position relative to the transplanted kidney and its initial size. CONCLUSIONS The correct evaluation of a fluid collection's dynamics of development and nature requires periodic follow-up of the recipient, preferably in a single clinical center. Ultrasonography is an inexpensive, non-invasive and repeatable method for the determination of the presence of fluid collections. However, the decision whether treatment is necessary requires the sonographic image to be compared with the laboratory signs of inflammation and biochemical analysis of the contents of fluid collections.
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Affiliation(s)
- Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Ewa Piasek
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Ewa Kuklik
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Słomka
- Department of Information Technology and Medical Statistics, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Olga Furmaga
- Department of Radiology, 424 General Military Hospital, Thessaloniki, Greece
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Guerrero-Ramos F, Cavero-Escribano T, Rodríguez-Antolín A, Andrés-Belmonte A, Passas-Martínez J, Tejido-Sánchez Á. Perigraft fluid collections after kidney transplantation: Does the type of donor (uncontrolled donation after circulatory death vs. donation after brain death) have a role? Cent European J Urol 2018; 70:439-444. [PMID: 29410900 PMCID: PMC5791392 DOI: 10.5173/ceju.2017.1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/28/2017] [Accepted: 09/18/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Perigraft fluid collection (PFC) is a common complication after kidney transplant. Its etiology is not clear and not all the causes have been identified. The influence of the type of donor has never been evaluated. Our aim was to compare the incidence, severity and management of PFC in recipients of grafts from uncontrolled donors after circulatory death (DCD) with normothermic extracorporeal membrane oxygenation (NECMO) versus recipients of grafts from donors after brain death (DBD). Material and methods We conducted a retrospective cohort study of 300 kidney transplants performed in our center between 2007 and 2012. Patients were divided in two groups: 150 recipients of Maastricht II DCD graft and 150 recipients of the DBD graft. Incidence, severity according to Clavien scale and management were analyzed in both groups, and comparison was carried out using Chi-square. Results Of the 300 kidney recipients analyzed, 93 (31.4%) suffered PFC, showing no difference between DBD (32.0%) and DCD (30.8%) groups (p = 0.9). Complicated PFC rate (defined as a PFC generating vascular compression, fever or urinary tract obstruction) was 22.9% in the DBD group versus 22.2% in the DCD group (p = 1); most complicated PFC were due to urinary tract obstruction (81%), with no difference between the groups (p = 1). Concerning Clavien scale, 78.5% of the PFC in our series were Clavien I, 19.4% Clavien IIIa and 2.2% Clavien IIIb, with no difference between both groups (p = 1). Conclusions PFC is a frequent complication that appears in a third of our patients, showing no difference in the incidence or severity between DBD and uncontrolled DCD graft recipients.
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11
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Towards non-invasive diagnostic techniques for early detection of acute renal transplant rejection: A review. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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12
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Khor YM, Lam WWC, Wong WY, Whatt Goh AS. Role of nuclear medicine imaging in evaluation of complications following renal transplant. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815611813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Evaluation of a failing renal allograft is a complex and challenging diagnostic problem. While ultrasonography with colour Doppler is usually the first approach for evaluation of graft dysfunction, radionuclide imaging is an excellent modality which provides complementary information regarding the perfusion and function of the allograft without any deleterious effect on the precious allograft. In this article, we review the imaging techniques of the nuclear medicine studies most commonly performed after renal transplant, discuss their roles and limitations in different clinical settings and illustrate with cases from our institution. Lastly, we will explore future development in the arena of nuclear imaging for renal transplant related complications.
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Affiliation(s)
- Yiu Ming Khor
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | | | - Wai Yin Wong
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
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Sfakianaki E, Sfakianakis GN, Georgiou M, Hsiao B. Renal scintigraphy in the acute care setting. Semin Nucl Med 2013; 43:114-28. [PMID: 23414827 DOI: 10.1053/j.semnuclmed.2013.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m ((99m)Tc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients. In this setting, there are common clinical entities which affect patients with native and transplant kidneys. In adult patients with native kidneys one of the most frequent reasons for emergency room visits is renal colic due to urolithiasis. Although unenhanced computed tomography is useful to assess the anatomy in cases of renal colic, it does not provide functional information. Time zero furosemide renal scintigraphy can do both and we have shown that it can effectively stratify patients with renal colic. To this end, 4 characteristic patterns of scintirenography have been identified, standardized, and consistently applied: no obstruction, partial obstruction (mild vs high grade), complete obstruction, and stunned (postdecompressed) kidney. With the extensive use of this protocol over the past 2 decades, a pattern of "regional parenchymal dysfunction" indicative of acute pyelonephritis has also been delineated. This information has proved to be useful for patients presenting with urinary tract infection and suspected pyelonephritis, as well as for patients who were referred for workup of renal colic but were found to have acute pyelonephritis instead. In instances of abdominal trauma, renal scintigraphy is uniquely suited to identify urine leaks. This is also true in cases of suspected leak following renal transplant or from other iatrogenic/postsurgical causes. Patients presenting with acute renal failure can be evaluated with renal scintigraphy. A scintigraphic pattern of "relative preservation of flow as compared to function" has been identified as indicative of acute tubular necrosis, which is distinct from other potential causes of acute renal failure, such as nephrotoxicity and in the case of renal transplants, rejection.
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Affiliation(s)
- Efrosyni Sfakianaki
- Department of Radiology, Division of Nuclear Medicine, University of Miami, Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA.
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14
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Rana Y, Singh D, Gupta S, Pradhan A, Talwar R, Harkar S, Swami Y. Urological and vascular complications in 720 renal transplantations – Lessons learned. INDIAN JOURNAL OF TRANSPLANTATION 2012. [DOI: 10.1016/j.ijt.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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