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Nephrol Dial Transplant (2003) 18: 1401-1404
© 2003 European Renal Association-European Dialysis and Transplant Association

Teaching Point

Two kidney-transplant women with therapy-resistant hypertension: diagnostic error of a renal artery stenosis

Gaëtan Clerbaux1,, Pierre Goffette2, Yves Pirson1 and Eric Goffin1

1 Department of Nephrology and 2 Department of Radiology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium

Keywords: angiography; colour Doppler ultrasound; gadolinium; magnetic resonance angiography; transplant renal artery stenosis

The first 10% of the full text of this article appears below.

Cases

Patient 1
This was a 57-year-old woman with end-stage renal disease (ESRD) due to chronic pyelonephritis who had received a cadaver kidney graft in July 1980 after 42 months of haemodialysis. Maintenance immunosuppression included azathioprine and prednisolone. Hypertension appeared a few months after kidney transplantation (KT) and was treated by methyldopa 250 mg three times a day. A systolo-diastolic murmur was noticed 6 months after KT. A first graft arteriography was performed in 1982. It revealed parietal irregularities with a <20% stenosis involving the first 2 cm of the transplant renal artery stenosis (RAS). In 2000, hypertension became resistant to a treatment combining isradipine and atenolol. Cockroft creatinine clearance and 24 h proteinuria were 72 ml/min and 150 mg, respectively.

A colour Doppler ultrasound (CDU) using a HDI 3000 machine with a 3.5 or 5 MHz sectorial transducer was performed. Peak systolic velocity (PSV) was measured at 3.36 . . . [Full Text of this Article]

Patient 2
Discussion

How to explain these two false-positive results of MRA?

Teaching points


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J. Gao, A. Ng, G. Shih, M. Goldstein, S. Kapur, J. Wang, and R. J. Min
Intrarenal Color Duplex Ultrasonography: A Window to Vascular Complications of Renal Transplants
J. Ultrasound Med., October 1, 2007; 26(10): 1403 - 1418.
[Abstract] [Full Text] [PDF]