title: Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do.
abstract: Kidney transplantation is the treatment of choice in end-stage renal disease, given the better quality of life of transplanted patients when compared with patients on maintenance dialysis. In spite of surgical improvements and new immunosuppressive regimens, parts of transplanted grafts still develop chronic dysfunction. Ultrasonography, both in B-mode and with Doppler ultrasound, is an important diagnostic tool in case of clinical conditions which might impair kidney function. Even though ultrasonography is considered fundamental in the diagnosis of vascular and surgical complications of the transplanted kidney, its role is not fully understood in case of parenchymal complications of the graft. The specificity of Doppler is low both in case of acute complications, such as acute tubular necrosis, drugs toxicity and acute rejection, and in case of chronic conditions, such as chronic allograft nephropathy. Single determinations of resistance indices present low diagnostic accuracy, which is higher in case of successive measurements performed during the follow-up of the graft. Modern techniques such as tissue pulsatility index, maximal fractional area and contrast-enhanced ultrasound increase ultrasonography diagnostic power in case of parenchymal complications of the transplanted kidney.
authors.affiliation: Nephrology and Dialysis Unit, "San Giovanni di Dio" Hospital, Agrigento, Italy ; Via F. Paradiso n°78/a, 95024 Acireale, CT Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Granata
authors.affiliation: Nephrology and Dialysis Unit, "Santa Maria della Scaletta" Hospital, Imola, Bo Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Di Nicolò
authors.affiliation: Nephrology and Dialysis Unit, "San Giovanni di Dio" Hospital, Agrigento, Italy.
authors.forename: Viviana R
authors.initials: VR
authors.lastname: Scarfia
authors.affiliation: Nephrology and Dialysis Unit, "San Giovanni di Dio" Hospital, Agrigento, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Insalaco
authors.affiliation: Nephrology and Dialysis Unit, "San Bassiano" Hospital, Bassano del Grappa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lentini
authors.affiliation: Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
authors.affiliation: Nephrology and Dialysis Unit, University Hospital of Catania, Catania, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fatuzzo
authors.affiliation: Nephrology and Dialysis Unit, "Santa Maria della Consolazione" Hospital, Rovigo, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Fiorini
keywords: Doppler ultrasound; Parenchymal complications; Renal transplantation; Ultrasonography