title: Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy.
abstract: Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion occurring in TRAS results in activation of the renin-angiotensin-aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash pulmonary edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syndrome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic sequelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of percutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention.
authors.affiliation: Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester, NY , USA ; Department of Medicine , Albert Einstein College of Medicine , Bronx, NY , USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Surgery , Albert Einstein College of Medicine , Bronx, NY , USA.
authors.forename: Liise K
authors.initials: LK
authors.lastname: Kayler
authors.affiliation: Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester, NY , USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Zand
authors.affiliation: Department of Medicine , Maimonides Medical Center , Brooklyn, NY , USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Muttana
authors.affiliation: Department of Radiology , Albert Einstein College of Medicine , Bronx, NY , USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Chernyak
authors.affiliation: Department of Medicine , Albert Einstein College of Medicine , Bronx, NY , USA.
authors.forename: Graciela O
authors.initials: GO
authors.lastname: DeBoccardo
keywords: Pickering syndrome; flash pulmonary edema; hypertensive crisis; renal artery pseudoaneurysm; transplant renal artery stenosis