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Colour coded duplex sonography (CCDS) is the method of choice in diagnostic monitoring of kidney transplants. Lack of radiation exposure, easy accessibility and high resolution have contributed to the fact that CCDS is used to monitor kidneys after transplantation. However, the value of CCDS in diagnosis of rejection is still a matter of debate. CCDS is used to evaluate perfusion of transplanted kidneys, detect renal artery stenosis or real vein thrombosis and arteriovenous fistulas. The value of recent technical advances, such as 3D Sonography, contrast harmonic imaging and tissue harmonic imaging, is currently being tested. This article focuses on indications and limitations of CCDS in the diagnosis of functional impairment of transplanted kidneys.

Calciphylaxis is a serious disease most commonly occurring in patients with end-stage renal disease characterized by systemic medial calcification of the arteries and tissue necrosis due to ischaemia. Secondary infections contribute to the high mortality of this disease. Diagnosis is suggested by characteristic skin lesions, calcifying septal panniculitis on deep skin biopsy and detection of calcifications in conventional radiology. We are able to demonstrate the early diagnosis with high resolution high frequency ultrasound prior to the occurrence of typical skin lesions facilitating early treatment.