Transplant renal artery stenosis

Case contributed by Dr Mohammad Eisa

Presentation

A known kidney transplant patient (3 years ago ), presented with hypertension and recently elevated kidney functions.

Patient Data

Age: 60 years
Gender: Male
Ultrasound

The kidney graft shows average size with normal echogenicity and good cortico-medullary differentiation. No stones or back pressure changes. It shows homogeneous internal vascularity on power Doppler. Increased renal arterial resistive index, varying between 0.76 and 0.93. The intra-renal arcuate arteries show damped monophasic Doppler waveform.

The renal transplant artery anastomosis shows aliasing on color Doppler. Spectral Doppler shows increased PSV about 4 m/s. The adjacent right external iliac artery shows maximum velocity of 170 cm/s. There’s therefore a 2.3 : 1 ratio between the transplant artery and external iliac

The renal vein is patent with proper respiratory variability.

Case Discussion

The findings are highly suggestive of transplant renal artery stenosis (TRAS).

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Case information

rID: 68667
Published: 11th Jun 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Al azhar university

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