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Fonseca de Jesus Silva C, Sosa Barrios RH, Burguera Vion V, Fernández Lucas M, Rivera Gorrín ME. Reversed diastolic intrarenal flow in page kidney following renal biopsy. J Ultrasound 2024:10.1007/s40477-023-00857-6. [PMID: 38413476 DOI: 10.1007/s40477-023-00857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/03/2023] [Indexed: 02/29/2024] Open
Abstract
Page's kidney is a condition that occurs due to external renal compression, usually caused by a subcapsular haematoma, generating a renal compartmental syndrome with parenchymal damage and renal perfusion alteration. Classically associated with renal trauma, Page's kidney can also arise after invasive renal procedures, such as renal biopsies or percutaneous nephrostomies. Clinically, it can trigger hypertension due to activation of the renin-angiotensin system induced by hypoperfusion secondary to renal parenchymal compression and can also present with varying degrees of renal function impairment. Furthermore, severe acute renal failure may be found particularly in patients with solitary kidneys or renal transplants. We present two cases of Page's kidney after renal biopsy and their PoCUS ultrasound findings. We would like to highlight the reversed diastolic flow on Doppler ultrasound in this entity, a pattern we have found in all two cases.
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Affiliation(s)
| | - R Haridian Sosa Barrios
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain.
- Sociedad Española de Nefrología: Pje. de Peña, 2, 39008 Santander, Cantabria, Madrid, Spain.
- , Ctra Colmenar Viejo km 9.1, 28034, Madrid, Spain.
| | - Víctor Burguera Vion
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- Sociedad Española de Nefrología: Pje. de Peña, 2, 39008 Santander, Cantabria, Madrid, Spain
| | - Milagros Fernández Lucas
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- Sociedad Española de Nefrología: Pje. de Peña, 2, 39008 Santander, Cantabria, Madrid, Spain
- Universidad de Alcalá de Henares, UAH, Madrid, Spain
| | - Maite E Rivera Gorrín
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- Sociedad Española de Nefrología: Pje. de Peña, 2, 39008 Santander, Cantabria, Madrid, Spain
- Universidad de Alcalá de Henares, UAH, Madrid, Spain
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Tang L, Lee T, Yuen L, Pleass H. Renal allograft compartment syndrome: a review. ANZ J Surg 2021; 91:2606-2609. [PMID: 34755448 DOI: 10.1111/ans.17271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/29/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Renal allograft compartment syndrome (RACS) is the result of extrinsic compression resulting in graft dysfunction and loss due to ischaemia. A literature review was performed by computerized searches from the following data sources Medline, EMBASE, PubMed and Cochrane Library databases. Risk factors include size mismatch between graft and recipient. Intraoperative suspicion should be exercised if there is poor tissue turgor, cyanosis and loss of urine output upon fascial closure. Doppler ultrasound is the modality of choice amongst the literature to aid in diagnosis of RACS. From our study, the accepted form of treatment is early detection and appropriate surgical intervention. Nevertheless, it is clear from the paucity of literature that further investigation into this area of transplantation is necessary.
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Affiliation(s)
- Linda Tang
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Taina Lee
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lawrence Yuen
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Henry Pleass
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Division of Surgery, University of Sydney, Sydney, Australia
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El-Bandar N, Lerchbaumer M, Hubatsch M, Lichy IM, Schulz MRG, Friedersdorff F. Renal Allograft Compartment Syndrome: A Case Report and Review of the Literature. Urol Int 2020; 104:646-650. [PMID: 32615567 DOI: 10.1159/000508799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
Abstract
Kidney transplantation is the treatment of choice for patients with ESRD. One rare complication after transplantation is the development of renal allograft compartment syndrome (RACS). We present a case of 1 patient who developed RACS due to compression of the transplant vein, which was then treated by salvaging the kidney transplant using urgent decompression surgery with mesh fascial closure. We postulate that this technique is safe and should be the treatment of choice for patients with RACS.
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Affiliation(s)
- Nasrin El-Bandar
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Markus Lerchbaumer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mandy Hubatsch
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Isabel Michaela Lichy
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias R G Schulz
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
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Feygina VM, Kotru A, Du C. Abdominal distention and continuous feeding intolerance after intraperitoneal kidney transplant: Answers. Pediatr Nephrol 2018; 33:607-609. [PMID: 28589211 DOI: 10.1007/s00467-017-3708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Valeriya M Feygina
- Department of Pediatrics, Division of Pediatric Nephrology, Geisinger Medical Center, Danville, PA, 17822, USA.
| | - Anil Kotru
- Department of Transplantation and LiverSurgery, Geisinger Medical Center, Danville, PA, 17822, USA
| | - Christine Du
- Department of Transplantation and LiverSurgery, Geisinger Medical Center, Danville, PA, 17822, USA
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Abstract
Renal allograft compartment syndrome (RACS) is graft dysfunction secondary to intracompartment hypertension. The purpose of this study was to identify risk factors for RACS. We reviewed 7 cases of established RACS and all intra-abdominal placements of the kidney in order to include potential RACS. We also studied early graft losses in order to rule out a missed RACS. We compared the allograft length and width, recipient height, weight, body mass index, aberrant vessels, site of incision, and side of kidney with the remainder of the cohort as potential predictors of RACS. Among 538 transplants, 40 met the criteria for actual RACS or potential RACS. We uncovered 7 cases of RACS. Only kidney length and width were statistically significant (P = 0.041 and 0.004, respectively). The width was associated with a higher odds ratio than was length (2.315 versus 1.61). Increased allograft length and width should be considered as a potential risk for RACS.
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Renal Allograft Compartment Syndrome: Is It Possible to Prevent? Transplant Proc 2016; 48:340-3. [DOI: 10.1016/j.transproceed.2015.12.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
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Wood L, Yang W, Annamalai A. Mesh Hood Fascial Closure Is a Safe Alternative to Prevent Renal Allograft Compartment Syndrome During Kidney Transplantation. Transplant Proc 2015; 47:1845-9. [DOI: 10.1016/j.transproceed.2015.04.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/15/2015] [Indexed: 12/22/2022]
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Unusual Causes of Abrupt Anuria Early Post-Renal Transplantation. Case Rep Transplant 2015; 2015:753159. [PMID: 26246931 PMCID: PMC4515500 DOI: 10.1155/2015/753159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/29/2015] [Indexed: 11/24/2022] Open
Abstract
Renal transplantation using living donors has superior outcomes in comparison to deceased donor transplantation and results in immediate allograft function in a majority of cases. Rarely may allograft be nonfunctional from the beginning, or anuria is noted after a period of good urine output. Surgical causes for anuria should be high on the differential diagnosis in immediate-to-early posttransplant period, especially in an unsensitized recipient. We present two unusual causes of early onset anuria after living related renal transplantation where early surgical reexploration salvaged renal allografts with excellent long term outcomes.
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Immediate postoperative sonography of renal transplants: vascular findings and outcomes. AJR Am J Roentgenol 2013; 201:W479-86. [PMID: 23971480 DOI: 10.2214/ajr.12.10310] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and types of significant vascular findings on bedside sonography immediately after renal transplantation and which abnormalities would suggest a benefit from early surgical revision. MATERIALS AND METHODS Five hundred seventy-five renal transplant sonograms obtained within 4 hours of surgery were retrospectively reviewed for major vascular abnormalities: lack of renal artery (RA) or renal vein (RV) flow, elevated peak systolic velocity (PSV)>300 cm/s, parvus tardus waveforms, and markedly decreased or no color parenchymal flow. Clinical outcomes of abnormal cases were reviewed, including reoperations and percutaneous interventions. RESULTS Thirty-two (5.6%) patients underwent repeat surgery within the first week, 16 for nonvascular causes. Forty-seven (8.2%) patients had positive sonography findings. In 16 patients, sonography impacted the decision for reoperation, with 14 confirmed vascular diagnoses: compartment syndrome (n=7), RV thrombosis (n=3), RA thrombosis (n=1), RA and RV thromboses (n=2), and vascular steal (n=1). All were salvaged except the three RV thromboses. Two patients had no vascular abnormality at surgery. All 16 had markedly decreased color flow and varying abnormalities of PSV and waveforms. Outcomes of the remaining 31 cases were infarct (n=1), renal or iliac artery stenoses eventually requiring stents (n=4), and normalized (n=26). These 26 had elevated PSV with normal or near-normal color flow. Unpaired Student t tests showed no significant difference in PSV between patients requiring surgery or stents and those who normalized (p=0.34). CONCLUSION Immediate postoperative sonography has a spectrum of vascular findings, of which markedly decreased color flow is most likely to benefit from immediate reoperation.
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