ROLE OF RENAL ULTRASONOGRAPHY AND DOPPLER IN DETECTION OF COMPLICATIONS OF POST-TRANSPLANTED KIDNEY

Abstract

Background: The increasing number of renal transplantations and the increased survival rate of renal transplantation patients lead to an increase of the number of complications. Complications of renal transplant can be diagnosed and managed with minimally invasive techniques. Radiologists must know about post-renal transplant complications, since it is essential to respond with early treatment, which improves the prognosis of the transplanted kidney. Most complications can be detected by Doppler and ultrasound, although on other occasions it is necessary to resort to other diagnostic techniques such as the CT Angiogram or arteriography. Objective: The aim of work was to highlight the role of ultrasound and duplex study in evaluation of early complications of the transplanted kidney. Patients and methods: This study included 30 renal transplant patients who were referred either for routine assessment of the renal allograft or for investigation of the cause of elevated serum creatinine levels. Patients selected from Ahmed Maher Teaching Hospital and Urology and Nephrology Center Mansoura University, in the period from November 2016 to August 2017. The patients were divided into two major groups: Group I: 20 patients with early complicated renal allografts, and Group II (Control Group): 10 patients with normal renal transplant grafts. Results: The perinephric complications have specific findings on the grey scale ultrasound while the Doppler may not reveal any significant findings. This study revealed that parenchymal complications were the most common early complications to occur after the kidney transplant surgery. The relation between the PSV of either the renal artery or the external iliac artery and the detection of early renal transplant complications in this study was insignificant. Ultrasound and Doppler showed different responses in relation to their specificity and sensitivity in the detection of early renal transplant complications. While Ultrasound was more accurate in detecting urological and perinephric complications showing sensitivity of 100%, Doppler appeared to have the upper hand in the detection of early vascular and parenchymal complications showing sensitivity ranging from 80-100 %. Conclusion: Doppler indices differ in their specificity and sensitivity in detecting the early renal transplant complications. Doppler indices in different arteries differ in the detection of early parenchymal renal transplant complications. In our study, Resistive index of the interlobar artery proved to be more specific in the detection of early cases of parenchymal complications in a renal transplant patient.