Tuesday, March 10, 2015

Topic Discussion: Renal Vein Thrombosis in the Allograft

0.5%-4% and frequently results in graft loss

Risk factors:
Technique error
Hypovolaemia Atherosclerosis OKT3 (plus high-dose methylprednisolone) Antiphospholipid antibodies High dose steroids Long cold ischaemia time Delayed graft function recovery

Certain renal diseases( membranous GN, SLE)
Antiphospholipid antibody syndrome
Use of oral contraception, 
Hereditary thrombophilia secondary to protein C or factor V deficiency

Clinical presentation:
Acute anuria, hematuria, graft tenderness, primary non function of the graft

Best test:
Renal sonogram with dopplers waveform evaluation( most important part)
A normal renal arterial waveform in either an allograft or native kidney shows antegrade flow throughout the entire cardiac cycle. Reversal of diastolic flow in the allograft renal artery, although not specific, is considered abnormal. This finding is caused by a significant increase in resistance in small intrarenal or large extrarenal vessels. This sign is not pathognomonic for renal vein thrombosis ( as can be seen with ATN or rejection as well).  Renal vein thrombosis was more likely to occur in the acute (24 hours) and perioperative (30 days) periods. It is important to recognize the abnormal duplex Doppler waveform pattern, reversal of diastolic flow, which is associated with renal vein thrombosis.

Timely returning back to the OR for thrombectomy and or reconstruction of venous component
Streptokinase or urokinase
Percutaneous mechanical thrombectomy and
Localized catheter-directed thrombolysis
But overall, prognosis is poor with many times leading to nephrectomy.

Two great reviews:

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