Sub-acute pyelonephritis in renal transplant

Case contributed by Dennis Odhiambo Agolah
Diagnosis almost certain

Presentation

Follow up renal graft ultrasound Doppler. Grafted kidney in use for approximately five years. Patient noted with elevated creatinine levels on recent laboratory tests.

Patient Data

Age: 40 Years
Gender: Male

Mild focal areas of increased echotexture of the transplanted renal cortical parenchyma suggesting an underlying sub-acute inflammatory process. Cortical- medullary differentiation and the allograft size is maintained. No calculi, hydronephrosis or peri-graft collections. Ipsilaterally, the transplanted intra-renal segmental (upper, mid and lower poles) arcuate and the interlober arterial Doppler waveforms and resistive indices (0.65, 0.56, 0.69, 0.68, 0.66 and 0.53) are normal with sharply rising systolic peaks and sharply falling end diastolic flows. No parvus pulsus or Tardus waveforms. The intra-renal venous supply, main renal artery and vein, the anastomosis site and the iliac vessels are unremarkable. The urinary bladder is normal in capacity and wall outline with no luminal masses or diverticulum and the bladder empties completely with no retention post voiding.

Case Discussion

The allograft renal cortex exhibit multifocal areas of increased reflectivity suggesting sub-acute inflammatory process which again is strengthened with the clinical/laboratory elevated creatinine values. The graft spectral Doppler study is normal with no features of rejection as yet. The native kidneys are visualized in their respective positions in their current end stage state.

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