title: A case of recurrent episodes of acute renal allograft failure caused by renal pedicle tortion.
abstract: BACKGROUND
  Acute allograft failure which occur intermittently after renal transplantation caused by graft tortion is a very rare entity. We here report highly unusual case of recurrent episodes of acute allograft dysfunction two years after kidney transplantation secondary to ischemic tubular necrosis caused by tortion of renal pedicle due to rotation of the allograft with body movements.
  
  
  METHODS
  A 55 year-old male patient with living unrelated kidney transplantation for chronic renal failure caused by autosomal dominant polycystic kidney disease had presented recurrent acute deteriorations in renal functions. All laboratory values were within normal limits except elevated serum creatinine levels, acute tubular necrosis in graft biopsy, and detection of pelvic dilatation in renal ultrasonography from time to time. Changes in axis of graft in nuclear medicine scans taken at different times during the same study made us bring to mind the diagnosis of renal pedicle tortion. Renal blood flow measurements with Doppler ultrasonography in different body positions helped to reach the final diagnosis of mobile kidney right on time. The patient is now well after prompt surgical treatment with nephropexy.
  
  
  CONCLUSIONS
  Unfortunately, tortion of allograft once occurred is associated with very high rate of graft loss due to arterial compromise and infarction and it is very difficult to diagnose without high level of suspicion. We discuss the causes of renal allograft tortion and the measures to prevent its occurrence and the methods to diagnose.
authors: Department of Nephrology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey. kkaynar@yahoo.com
authors: Kubra
authors: K
authors: Kaynar
authors: Bircan
authors: B
authors: Sonmez
authors: Omer
authors: O
authors: Kutlu
authors: Sukru
authors: S
authors: Ulusoy
authors: Muammer
authors: M
authors: Cansiz
authors: Serdar
authors: S
authors: Turkyilmaz
authors: Aysegul
authors: A
authors: Cansu
authors: Sevdegul
authors: S
authors: Mungan
mesh_terms: D000208:Acute Disease; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014102:Torsion Abnormality / Q000150:complications / Q000175:diagnosis*; D014184:Transplantation, Homologous / Q000009:adverse effects