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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Owing to the noninvasive nature, ready availability, and efficacy, radionuclide studies remain widely utilized following renal transplantation for monitoring changes in the functional status and detection of detrimental complications of the grafted kidney. Whereas surgical complications, including vascular occlusion, urine extravasation, drainage obstruction, hematoma, or lymphocele formation, can often be detected effectively, specification of other underlying causes of deterioration of parenchymal function, including acute tubular necrosis (ATN), various types of rejection, and cyclosporine A nephrotoxicity (CyA-NT), frequently cannot be derived independently from the findings of a study without clinical correlation. Besides imaging, plotting of renogram or time/activity curves, numerous quantitative methods have been introduced to provide objective measurements of the blood flow, as well as to gauge the capability of concentration and excretion of the transplanted kidneys. However, the findings whether qualitative or quantitative all have overlapping zones. There is no abnormal image, graphic, or numeric index absolutely specific for any of the possible posttransplant renal parenchymal complications. The differentiation of such conditions may best be achieved through chronologic association of the sequential changes, with or without quantification, detected in serial studies with the clinical presentation and findings.
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PMID:Radioisotopic evaluation of renal transplants. 150 28

A case of lymphocele after an allograft renal transplant at the National Taiwan University Hospital is reported. A 32-year-old female patient received a kidney transplant from a cadaver donor on 23 November 1990 after a 10-year course of hemodialysis. Acute tubular necrosis of 31 days duration developed on the 6th postoperative day after a severe episode of acute rejection. On the 44th POD, sonographic examination showed an echo-free space between the graft and the urinary bladder. Emergent marsupialization through an intraperitoneal window of the lymphocele was performed on the 45th POD due to a sudden decrease in urine output. After releasing the compression of the lymphocele, the urine output returned to over 2,500 mL on the following day. The patient was discharged on the 63rd POD with normal renal function. Repeated sonographic examination showed no reaccumulation of lymphocele. The literature concerning lymphocele is reviewed.
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PMID:Lymphocele after renal transplantation: a case report. 168 92

Perinephric abscess has no characteristic ultrasonic appearance or location. Differentiation from urinoma, lymphocele, or hematoma depends on clinical and laboratory findings. Therapy consists of percutaneous catheter drainage, surgical drainage, and antibiotic therapy. Acute rejection is the most common cause of decreased diastolic flow during the immediate postoperative period. Acute tubular necrosis does not usually alter blood flow unless it is severe. Duplex doppler ultrasonic assessment of the renal transplant during the immediate postoperative period may provide a valuable baseline for comparison if complications develop. Baseline and follow-up ultrasonography to evaluate diastolic flow can help determine whether a posttransplant patient should receive emergency or conservative therapy for complications.
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PMID:Duplex Doppler examination of a perinephric abscess in a renal transplant. 221 64

Tc-99m DTPA scintigraphic findings in patients with postoperative complications of renal transplantation were presented. In acute tubular necrosis, excretion of the tracer was not observed though its perfusion was preserved. In acute rejection, perfusion was reversibly disturbed. In chronic rejection, perfusion was irreversibly disturbed. In renal infarction, multiple defects were observed. In renal vein thrombosis, similar pattern to acute tubular necrosis was found but RI venography was helpful. In lymphocele, perirenal photon deficiency was observed. In renal artery thrombosis, absence of the perfusion and total photon deficient were noted. Tc-99m DTPA renal scintigraphy is useful for diagnosis and follow up of the complications of transplanted kidneys.
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PMID:[Tc-99m DTPA scintigraphic findings in patients with postoperative complications of renal transplantation]. 268 14

Renal transplantation is the treatment of choice for adults and children with end-stage renal disease. More than 7500 kidney transplants are performed in the United States each year with an average 2-year graft survival rate of 95, 85, and 75 per cent for HLA-identical, living related, and cadaver donor recipients, respectively. New immunosuppressive modalities including donor specific transfusions and cyclosporine have resulted in improved results with fewer infectious complications. Careful attention to hemostasis, minimization of tissue injury, and aseptic technique is necessary in uremic and immunosuppressed patients. The most common complications requiring radiologic evaluation and treatment after renal transplantation include acute tubular necrosis, renal artery or renal vein thrombosis, lymphocele, ureteral necrosis, bladder disruption, bleeding, ureteral obstruction or stricture, and renal artery stenosis. The most useful radiologic studies are renograms, echograms, computed axial tomograms, cystograms, arteriograms, percutaneous nephrostograms, and intravenous or retrograde pyelograms.
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PMID:Renal transplantation: clinical considerations. 354 72

The reliability of ultrasonography in detecting complications of renal transplantation was investigated by reviewing the ultrasound examination on 78 renal transplants. The results of the ultrasound examinations were correlated with all available clinical, laboratory, radiographic, scintigraphic, and histopathologic data. With the exception of one urine leak no extrarenal complications of clinical significance, such as hydronephrosis, urine leak, lymphocele or hematoma were overlooked at ultrasonography. The exact nature of fluid collections was, however, only seldom accurately assessed unless fine needle biopsy was used. The accuracy in detecting both acute and chronic rejection was high with ultrasonography and a normal ultrasonography of a non-functioning kidney was a strong indication of acute tubular necrosis. Ultrasonography was very sensitive in detecting early acute rejection but was of less value in diagnosing repeated acute rejections with short intervals and in monitoring the response of treatment as the sonographic changes of rejection disappeared slowly.
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PMID:Ultrasonography in complications of renal transplantation. 638 28

Nineteen patients were examined to determine the clinical potential of magnetic resonance imaging (MRI) for evaluation of renal transplants. A 0.6-T cryogenic magnet and spin-echo technique with varying pulsing factors were used. T1-weighted images were best for differentiating the cortical and medullary parts of the transplanted kidney. Of the six living-related transplants with good renal function that were imaged, five demonstrated good corticomedullary differentiation (CMD) and one faint CMD. Three transplants with acute rejection were imaged, and all demonstrated a decrease in CMD and decrease in overall signal intensity compared with baseline. No CMD was seen in the three chronically rejecting transplants imaged. The appearance of cadaveric transplants and acute tubular necrosis was quite variable. All perinephric fluid collections were well depicted by MRI. Lymphoceles could be distinguished from hematomas. MRI may prove to be a useful adjunct in the evaluation of renal transplants and perinephric fluid collections.
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PMID:Magnetic resonance imaging of renal transplants. 638 81

Lymphoceles are a complication of renal transplantation surgery. The source of this lymphatic collections is the lymph draining through the lymphatic vessels located in the transplanted kidney sinus and surrounding the iliac vessels of the receptor. The main etiological factor is the surgical technique used when dissecting these structures for graft placement. Several factors have been suggested as favouring their occurrence, acute rejection being highlighted as one. This paper reviews a series of 517 renal transplantations performed in our service, with a lymphocele incidence of 5.2% (28). Using a log regression model, the influence of age, sex, time in dialysis, presence of tubular acute necrosis in the graft following placement, acute rejection and immunological regime, for the appearance of lymphocele were analyzed. Age and lack of acute tubular necrosis were the only two factors selected by the model. Also, clinical signs and symptoms as well as therapy instituted were analyzed, emphasizing that puncture-drainage and instillation of iodine povidone was 100% effective.
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PMID:[Lymphocele as a complication of renal transplantation]. 797 92

To define better the prevalence and pathophysiology of lymphoceles following renal transplantation, we prospectively evaluated 118 consecutive renal transplants performed in 115 patients (96 cadaveric, 22 living-related, 7 secondary and 111 primary). Ultrasonography was performed post-operatively and during rehospitalizations or whenever complications occurred. Perirenal fluid collections were identified in 43 patients (36%). Lymphoceles with a diameter of 5 cm. or greater were identified in 26 of 118 cases (22%). Eight patients (6.8%) had symptomatic lymphoceles requiring therapy. The interval for development of symptomatic lymphoceles was 1 week to 3.7 years (median 10 months). Risk factors for the development of lymphoceles were examined by univariate and multivariate analysis, and included patient age, sex, source of transplants (cadaver versus living-related donor), retransplantation, tissue match (HLA-B/DR), type of preservation, arterial anastomosis, occurrence of acute tubular necrosis-delayed graft function, occurrence of rejection, and use of high dose corticosteroids. Univariate analysis showed a significant risk for the development of lymphoceles in transplants with acute tubular necrosis-delayed graft function (odds ratio 4.5, p = 0.004), rejection (odds ratio 25.1 p < 0.001) and high dose steroids (odds ratio 16.4, p < 0.001). When applying multivariate analyses using stepwise logistic regression, only rejection was associated with a significant risk for lymphoceles (symptomatic lymphoceles--odds ratio 25.08, p = 0.0003, all lymphoceles--odds ratio 75.24, p < 0.0001). When adjusting for rejection, no other risk factor came close to being significant (least p = 0.4). Therapy included laparoscopic peritoneal marsupialization and drainage in 1 patient, incisional peritoneal drainage in 4 and percutaneous external drainage in 3 (infected). All symptomatic lymphoceles were successfully treated without sequelae to grafts or patients. We conclude that allograft rejection is the most significant factor contributing to the development of lymphoceles. Therapy of symptomatic lymphoceles should be individualized according to the presence or absence of infection.
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PMID:Post-transplant lymphoceles: a critical look into the risk factors, pathophysiology and management. 851 Feb 62

Povidone-iodine sclerosis has been suggested in the literature as a safe and effective treatment for post-renal transplant lymphoceles. No significant complications of this method have been described. We report on a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine instillations who developed acute renal failure secondary to iodine intoxication. Four days after the beginning of the povidone-iodine irrigations, metabolic acidosis was present, and renal function started to deteriorate. After a few days, despite the suspension of irrigations, the patient developed oliguria, and dialysis was needed. A renal biopsy was performed, and intense acute tubular necrosis was the only relevant finding. The lymphocele was corrected surgically, and the patient eventually recovered. As has been described in other settings, povidone-iodine instillation for the treatment of post-renal transplant lymphoceles may lead to iodine kidney toxicity and acute renal failure.
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PMID:Nephrotoxic acute renal failure in a renal transplant patient with recurrent lymphocele treated with povidone-iodine irrigation. 1220 Aug 20


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