Presentation
A known kidney transplant patient (3 years ago) presents with hypertension and recently elevated kidney function.
Patient Data
The kidney transplant is of 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 a 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 a maximum velocity of 170 cm/s. There is, therefore, a 2.3:1 ratio between the transplant artery and the external iliac artery.
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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