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Normal retrograde pyelography of a native and transplant kidney

Case contributed by Matt A. Morgan
Diagnosis certain

Presentation

Patient post right lower quadrant renal transplant two years prior. Presents with microhematuria.

Patient Data

Age: 60 years
Gender: Male

On the scout image, there are ureteral catheter positioned in the transplant ureter (right) and native left ureter.

The transplant ureter, the ureteral anastomosis, and the distal  right ureter are normal in appearance.

Other than mild blunting of the left renal calyces, the left ureter and upper collecting system are also normal.

Case Discussion

Retrograde pyelography is rarely used as a first line study for evaluation of the urinary collecting system. Usually CTU or ultrasound is pursued first.

Retrograde pyelography can be especially useful to evaluate renal transplant ureters since these are likely to be poorly imaged on CTU and since it can avoid an intravenous contrast dose with possible deleterious effects on poor renal function.

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