Percutaneous treatment of transplant renal artery stenosis in children.
Percutaneous treatment of renal artery stenosis (RAS) is an accepted procedure and numerous reports have been published. However, experience with its use in RAS in the transplanted kidney in children is scarce. Since 1994 we have diagnosed RAS in seven children with the use of Doppler ultrasonography (US), confirming it with percutaneous angiography (PAG). In six of the seven patients percutaneous transluminal angioplasty (PTA) was performed. In one patient a metallic stent was placed due to the extension of the arterial lesion, and a second stent was placed in another child when a re-stenosis was diagnosed 1 month after the PTA. All patients presented with hypertension (de novo or 30% increase over previous values). After ruling out acute rejection, calcineurin inhibitor toxicity, and urinary obstruction, US was performed and, when an increase in arterial flux velocity was registered, PAG was also performed. Six children showed an increase in serum creatinine (Cr) and proteinuria. Blood pressure decreased after the procedure and Cr returned to previous levels in all children. One of the grafts was lost due to chronic transplant rejection 7 years later. The other children have a functioning kidney. Although this is a small group of patients, the consistently good results and the lack of reported experience prompted us to communicate our preliminary observation.
Repetto
Horacio A
HA
Departamento de Transplante Pediátrico, Instituto de Nefrología, Buenos Aires, Argentina. arepetto@intramed.net.ar
Rodríguez-Rilo
Laila
L
Mendaro
Esteban
E
Basso
Laura
L
Galvez
Hugo
H
Morrone
Gabriela
G
Vazquez
Luis A
LA
D000800:Angioplasty, Balloon; D002648:Child; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D012078:Renal Artery Obstruction / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies