Diagnosis of renal artery stenosis in transplanted kidneys: value of Doppler waveform analysis of the intrarenal arteries.

Gottlieb, Ronald H.; Lieberman, J L; Pabico, RC; Waldman, David L.

doi:10.2214/ajr.165.6.7484582

Cited by 67 publications

(27 citation statements)

References 10 publications

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“…DU, although most readily available and inexpensive, does require considerable operator skill in imaging the origins of the renal arteries where TRAS commonly occurs (14,15). A peak Doppler velocity exceeding 200 cm/s with color aliasing at the site of stenosis with renal to external iliac artery peak velocity ratio exceeding 2 are good indicators of the presence of stenosis (16).…”

Section: Discussionmentioning

confidence: 99%

“…The median time in months from transplantation to diagnosis of TRAS was Transplant Renal Artery Stenosis 4.1 (range 1. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Upon presentation, all 12 patients were hypertensive and had allograft dysfunction, more than half (7/12) had dependent edema, and a quarter had a bruit on auscultation.…”

Section: Clinical Presentation Of Trasmentioning

confidence: 99%

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The Use of Drug-Eluting Stents in the Management of Transplant Renal Artery Stenosis

Abate

Kaur

Suh

et al. 2011

American Journal of Transplantation

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Transplant renal artery stenosis (TRAS) is a common occurrence following kidney transplantation with an incidence rate ranging from 6% to 23%. A single-center retrospective study was conducted to examine the use of drug-eluting stents (DES) in eligible patients with hemodynamically significant TRAS. Between March 2008 and January 2011, 12 patients were diagnosed with TRAS with reference vessel diameter measuring <5 mm and underwent endovascular intervention (EVI) with DES placement. TRAS was detected within the first year posttransplantation in a majority of these patients (83%) and manifested as hypertension (100%), allograft dysfunction (100%) and edema (58%). Procedural success rate was 100%. Patients were followed for a mean period of 16 ± 10 months. Blood pressure improved from a mean of 156/82 to 138/73 mmHg at the end of the follow-up period. In 11/12 patients, serum creatinine improved from 3.1 ± 1.3 mg/dL to 2.3 ± 0.5 mg/dL at the end of the follow-up period. TRAS of early onset is readily amenable to EVI with stent placement resulting in improvement in blood pressure control and allograft function.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Presentation Of Trasmentioning

confidence: 99%

The Use of Drug-Eluting Stents in the Management of Transplant Renal Artery Stenosis

Abate

Kaur

Suh

et al. 2011

American Journal of Transplantation

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“…The first studies regarded a blood flow velocity of 100 cm/s as the upper limit, while later research suggested the limit should be 170 -200 cm/s. In these studies sensitivity was 81% -92% and specificity was 87% -96% (Gottlieb et al, 1995;House et al, 1999;Krumme et al, 1996;Miralles et al, 1996). However, the renalaortic ratio obtained by dividing the renal artery flow velocity by the abdominal aorta flow velocity can be used to eliminate individual differences.…”

Section: Renal Artery Stenosis and Occlusionmentioning

confidence: 99%

The Evaluation of Renal Hemodynamics with Doppler Ultrasonography

Kaya¹

2012

Hemodynamics - New Diagnostic and Therapeutic Approaches

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“…The lack of variation in waveform morphology between donors and recipients confirmed the restoration of a regular low-resistance flow pattern of a normal kidney [20,21]. CDUS evaluation of the intraparenchymal renal resistance is useful alongside the monitoring of biochemical parameters in the follow-up of normally functioning allografts.…”

Section: Discussionmentioning

confidence: 72%

Role of color Doppler ultrasound in the evaluation of renal transplantation from living donors

et al. 2014

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Purpose The aim of this study was to evaluate the same kidney before and after transplantation to assess the ability of the allograft to restore blood flow, time required to achieve functional recovery after surgery and the possibility of differentiating normal from pathological allografts using color Doppler ultrasound (CDUS) flow indices: resistive index (RI)/renal cortical ratio (RCR) and scintigraphy. Materials and methods 79 living donors and 79 recipients. Donors underwent renal CDUS and scintigraphy. CDUS was repeated on the allograft 24 h, 3, 15 and 30 days after transplantation, and scintigraphy 3-5 days after transplantation. Recipients were divided into two groups on the basis of clinical and biochemical values: (A) well-functioning allografts and (B) acute pathology. Results of CDUS, RI and RCI were compared to results of scintigraphy, biochemical values and biopsy. Results Group (A) n = 60 (76 %), group (B) n = 19 (24 %); RI sensitivity was 93 %, specificity 83 %. In group (A) positive predictive value (PPV) was 94 % and in group (B) 90 %. RCR using receiver operating characteristic curve analysis yielded sensitivity 100 % and specificity 98.3 %. Scintigraphy mean values of glomerular filtration ratio and T max before transplantation were in group (A): 50.32 ml/min and 4.87 min; after transplantation 46.88 ml/ min and 4.96 min; in group (B): 48.68 ml/min and 4.63 min, after transplantation 27.89 ml/min and 10.53 min, respectively. Pearson's correlation coefficient between preoperative and postoperative results of scintigraphy was significant in group (A) (glomerular filtration ratio = 0.85, T max = 0.70) and not significant in group (B) (glomerular filtration ratio = 0.40, T max = 0.08). Conclusion This study shows that CDUS, RI and RCR are useful in postoperative evaluation of transplanted kidneys as these parameters can, after only 24 h, confirm the good condition of the allograft despite still excessive blood parameter values.Keywords Color Doppler Á Ultrasound Á Renal transplantation Á Living donor Á Blood flow indices Riassunto Scopo Scopo di questo studio è stato di valutare lo stesso rene prima e dopo il trapianto al fine di valutare la capacità dell'organo trapianto di ripristinare il flusso sanguigno, il tempo richiesto per raggiungere il recupero funzionale dopo l'intervento chirurgico e per differenziare nell'innesto il tessuto normale dal patologico con l'uso degli indici di flusso del color Doppler (CD): l'indice di resistenza (IR)/ renal cortical ratio (RCR) e la scintigrafia. Materiali e Metodi 79 donatori viventi e 79 riceventi. I donatori sono stati sottoposti a CD renale e a scintigrafia. Il CD è stato ripetuto sul tessuto trapiantato 24 ore, 3, 15 e 30 giorni dopo il trapianto e la scintigrafia, 3-5 giorni dopo il trapianto. I pazienti sono stati divisi in due gruppi sulla base dei dati clinici e biochimici: A) trapianto ben funzionante e B) patologia acuta. I risultati del CD, IR e RCR sono stati confrontati con i risultati della scintigrafia, i valori biochimici e la bio...

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Diagnosis of renal artery stenosis in transplanted kidneys: value of Doppler waveform analysis of the intrarenal arteries.

Cited by 67 publications

References 10 publications

The Use of Drug-Eluting Stents in the Management of Transplant Renal Artery Stenosis

The Use of Drug-Eluting Stents in the Management of Transplant Renal Artery Stenosis

The Evaluation of Renal Hemodynamics with Doppler Ultrasonography

Role of color Doppler ultrasound in the evaluation of renal transplantation from living donors

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