title: Power doppler sonography in early renal transplantation: does it differentiate acute graft rejection from acute tubular necrosis?
abstract: To evaluate the role of power Doppler in the identification and differentiation between acute renal transplant rejection and acute tubular necrosis (ATN), we studied 67 live donor renal transplant recipients. All patients were examined by spectral and power Doppler sonography. Assessment of cortical perfusion (CP) by power Doppler was subjective, using our grading score system: P0 (normal CP); homogenous cortical blush extending to the capsule, P1 (reduced CP); cortical vascular cut-off at interlobular level, P2 (markedly reduced CP); scattered cortical color flow at the interlobar level. Renal biopsies were performed during acute graft dysfunction. Pathological diagnoses were based on Banff classification 1997. The Mann- Whitney test was used to test the difference between CP grades with respect to serum creatinine (SCr), and resistive index (RI). For 38 episodes of acute graft rejection grade I, power Doppler showed that CP was P1 and RI ranging from 0.78 to 0.89. For 21 episodes of acute graft rejection grade II, power Doppler showed that CP was P1, with RI ranging from 0.88 to >1. Only one case of grade III rejection had a CP of P2. Twelve biopsies of ATN had CP of P0 and RI ranging from 0.80 to 0.89 There was a statistically significant correlation between CP grading and SCr (P <0.01) as well as between CP grading and RI (P <0.05). CP grading had a higher sensitivity in the detection of early acute rejection compared with RI and cross-sectional area measurements. We conclude that power Doppler is a non-invasive sensitive technique that may help in the detection and differentiation between acute renal transplant rejection and ATN, particularly in the early post-transplantation period.
authors: Haytham M
authors: HM
authors: Shebel
authors: Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt.
authors: Ahmed
authors: A
authors: Akl
authors: Ahmed
authors: A
authors: Dawood
authors: Tarek A
authors: TA
authors: El-Diasty
authors: Ahmed A
authors: AA
authors: Shokeir
authors: Mohamed A
authors: MA
authors: Ghoneim
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007683:Kidney Tubular Necrosis, Acute / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012079:Renal Circulation; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult