Objective measurement by ultrasound to distinguish cyclosporin A toxicity from rejection

Parvin, S.D.; McDermott, Yvonne; Veitch, P. S.; Bell, P. R. F.

doi:10.1002/bjs.1800731226

Cited by 19 publications

(1 citation statement)

References 14 publications

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“…The typical picture is of renal enlargement with an expanded, echogenic cortex and is indistinguishable from acute rejection. Toxicity from calcineurin inhibitors does not produce any sonographic changes [21,22,23]. …”

Section: Acute Renal Failure In Renal Transplantsmentioning

confidence: 99%

B-Mode Sonography in Acute Renal Failure

O’Neill¹

2006

Nephron Clin Pract

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B-mode sonography is an extremely useful and cost-effective method to eliminate urinary obstruction as a cause of acute renal failure and should be performed on all patients in whom obstruction is likely or in whom the cause of renal failure is not apparent. The threshold should be reduced in patients with solitary kidneys and sonography is probably indicated in all transplant patients. Sonography has very little utility in the management of other patients with acute renal failure. Although sonographic changes do occur in acute tubular necrosis, they are difficult to detect in the absence of baseline studies and are nonspecific.

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Section: Acute Renal Failure In Renal Transplantsmentioning

confidence: 99%

B-Mode Sonography in Acute Renal Failure

O’Neill¹

2006

Nephron Clin Pract

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Prospective study of the value of ultrasound measurements in the diagnosis of acute rejection following renal transplantation

Nicholson

Williams

Bell

et al. 1990

Journal of British Surgery

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In this prospective study we have used ultrasonographic measurements of the cross-sectional area of transplanted kidneys, as an objective assessment of graft size, for diagnosis of acute rejection episodes. Sixty episodes of acute graft dysfunction (serum creatinine rise of greater than or equal to 30 mumol/l) were studied in 40 patients. Tru-Cut biopsy under ultrasound control was performed in all cases and 36 episodes of acute cellular rejection were identified. An increase in graft cross-sectional area of greater than or equal to 10 per cent was defined as a positive scan, indicative of an acute rejection episode. Using these criteria, ultrasound correctly diagnosed rejection in 29 out of 36 cases (sensitivity 81 per cent) and there were four false positive results (specificity 83 per cent). The investigation had a predictive value of 88 per cent when positive and 74 per cent when negative.

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Probability of rejection predicted from ultrasonographic measurement of renal transplant swelling

Nicholson

Bell

Burton

et al. 1993

Journal of British Surgery

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Serial ultrasonographic measurements of renal transplant cross-sectional area were used to quantify allograft swelling as a diagnostic test of acute rejection. Eighty consecutive episodes of acute allograft dysfunction (rise in creatinine level > or = 10 per cent or > or = 30 mumol l-1) were investigated. Needle core biopsy was performed in all cases to diagnose acute rejection. Rejecting transplants demonstrated a median (interquartile range) swelling of 16.2 (12.1-25.5) per cent compared with 2.2 (-2.0 to 8.4) per cent for non-rejecting organs (P < 0.001). A > or = 10 per cent increase as the diagnostic threshold for rejection yielded a sensitivity of 80 per cent, specificity of 77 per cent, positive predictive value of 85 per cent, negative predictive value of 71 per cent and overall accuracy of 79 per cent. Using a logistic regression model, predictive probabilities of rejection for individual changes in cross-sectional area were calculated. A 20 per cent increase was associated with a predicted probability of rejection of 87 per cent (95 per cent confidence interval 75-94 per cent). There was a significant correlation between the functional severity of rejection and the degree of transplant swelling (rs = 0.63, P < 0.001). Ultrasonographic measurement of renal transplant cross-sectional area is a simple non-invasive test for the diagnosis of acute rejection.

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Objective measurement by ultrasound to distinguish cyclosporin A toxicity from rejection

Cited by 19 publications

References 14 publications

B-Mode Sonography in Acute Renal Failure

B-Mode Sonography in Acute Renal Failure

Prospective study of the value of ultrasound measurements in the diagnosis of acute rejection following renal transplantation

Probability of rejection predicted from ultrasonographic measurement of renal transplant swelling

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