Postural renal transplant obstruction: a case report and review of the literature.
A 48-year-old woman underwent cadaveric renal transplantation for end-stage renal failure secondary to polycystic kidney disease. Nine months after transplantation, intermittent renal dysfunction and severe graft hydronephrosis developed despite the presence of a ureteric stent. A Tc-99m MAG3 scan performed with the patient standing showed complete transplant obstruction. Rapid tracer clearance with progressive bladder filling was present when the patient was imaged in the supine position. Ureteric obstruction is the most common urologic complication of renal transplantation. However, postural ureteric obstruction has been described only rarely. This case indicates that posture may affect ureteric patency and highlights this potential pitfall in the evaluation of intermittent graft dysfunction by diuretic renography.
Cohn
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DA
Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Westmead, New South Wales, Australia.
Gruenewald
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S
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D007690:Polycystic Kidney Diseases / Q000150:complications / Q000601:surgery; D011187:Posture; D011877:Radionuclide Imaging; D018570:Risk Assessment; D017263:Technetium Tc 99m Mertiatide; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D014567:Urography / Q000379:methods
D017263:Technetium Tc 99m Mertiatide