Renal Transplant Flashcards
where do you typically find transplant kidneys attached to?
attached to the hypogastric artery and external iliac vein and placed into anterior iliac fossa (R>L)
RP and dose
MAG3 or DTPA
imaging protocol
dynamic imaging (see the flow of blood to kidney)
immediate static of abdomen?
during flow phase… activity should appear in the kidney within _____
2-5 secs of appearing in the adjacent iliac artery
during the functional phase, peak activity at ____
3-5 mins
during the clearance phase, filling of calyces and pelvis by ______
3-5 mins
bladder typically seen by ____ in the clearance phase
4-8 mins
medical pathologies that are unique to renal transplants
- rejection (hyperacute, accelerated acute, acute, chronic)
- acute tubular necrosis/delayed graft function
- immunosuppressive drug toxicity/nephrotoxicity
surgical pathologies that are unique to renal transplants
- urine extravasation (urinoma)
- hematoma
- lymphocele
- renal artery or vein thrombosis
- ureteral obstruction
symptoms of tx complications
- decreased renal function
- HTN
- weight gain
- tenderness and graft swelling but no renal pain
- fever
- proteinuria, hematuria, lymphocytes in urine
- elevated creatinine and urea
hyperacute
within minutes of tx
obvious in OR
accelerated acute
1-5 days post tx
acute
7+ days post tx
most likely in first 2-3 months
what type of rejection is typically seen in NM?
acute and chronic
chronic
months to years
what type of tx rejection has cellular mediated immune response?
acute
what type of tx rejection has antibody mediated immune response?
chronic
appearance of acute rejection
decreased perfusion and diminished uptake and excretion
appearance of chronic rejection
initially looks normal
serial imaging = slow decline in renal function, increased parenchymal retention, delayed excretion = cortical thinning and patchy uptake
till eventually no uptake at all (renal failure)
how do you reduce the risk of rejection?
a nice drug cocktail that has a strict timing regimen
what mimics renal tx rejection?
cyclosporine/tacrolimus toxicity
another term for acute tubular necrosis (ATN)
delayed graft function
what is ATN?
ischemia that happened between harvest and transplant
symptoms of ATN
decreased urine output within first few days after tx (will resolve within few days to weeks)
renogram of ATN
minimally decreased perfusion
decreased function therefore increased cortical retention
improves in serial imaging!
differentiate between ATN and drug toxicity renograms
they look similar, normal perf, but due to reduced function there will be retention of tracer
what is the key to diagnosing ATN vs. drug toxicity?
dependent on when study was done. if seen during exam that was done within 2 days of post tx = ATN
while if done weeks to months post tx = drug toxicity
which RP is useful to test for leaking?
MAG3 as it has better T:NT
which RP is better to few potential reduced functioning kidneys?
DTPA as MAG3 as hepatobiliary excretion
appearance of surgical urine leaks and urinomas
urine outside collecting system, ureters or bladder
can be seen as photopenic defect if it is a slow leak and/or cyst with urine inside
appearance of a hematoma
photon deficient area for the first few days after tx
appearance of lymphocele
photon deficient area for the first 2-4 months after tx
what is lymphocele?
extrarenal collection of lymphatic fluid that can cause ureteral or iliac vein compression
appearance of vascular complications
photopenic kidney with possible hot rim
