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Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

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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.

Sommario

Il trapianto di rene è il trattamento di scelta nella malattia renale allo stadio terminale, data la migliore qualità di vita dei pazienti trapiantati rispetto a quelli che continuano il trattamento dialitico. Nonostante i miglioramenti chirurgici e nuovi regimi immunosoppressivi, parte dei pazienti trapiantati sviluppano ancora disfunzioni croniche. L’ecografia, sia in B-mode che Doppler, è un importante strumento diagnostico in caso di condizioni cliniche che possono alterare la funzione renale. Anche se l’ecografia è considerata fondamentale nella diagnosi di complicanze chirurgiche e vascolari del rene trapiantato, il suo ruolo non è pienamente conosciuto in caso di complicanze parenchimali. La specificità del Doppler è bassa, sia in caso complicanze acute, quali la necrosi tubulare acuta, la tossicità acuta da farmaci, il rigetto, sia in caso di complicanze croniche, come la nefropatia cronica del trapianto. Singole determinazioni di indici di resistenza presentano bassa accuratezza diagnostica, che è più elevata in caso di misure effettuate successivamente durante il follow-up del trapianto. Tecniche moderne, come l’indice di pulsatilità tissutale, massima frazione di zona ed ecografia con mdc aumentano le potenzialità diagnostiche dell’ecografia in caso di complicanze parenchimali del rene trapiantato.

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Conflict of interest

Antonio Granata, Pierpaolo Di Nicolò, Viviana R. Scarfia, Monica Insalaco, Paolo Lentini, Massimiliano Veroux, Pasquale Fatuzzo, Fulvio Fiorini declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent for enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

Human and animal studies

The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.

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Authors and Affiliations

  1. Nephrology and Dialysis Unit, “San Giovanni di Dio” Hospital, Agrigento, Italy

    Antonio Granata, Viviana R. Scarfia & Monica Insalaco

  2. Nephrology and Dialysis Unit, “Santa Maria della Scaletta” Hospital, Imola, Bo, Italy

    Pierpaolo Di Nicolò

  3. Nephrology and Dialysis Unit, “San Bassiano” Hospital, Bassano del Grappa, Italy

    Paolo Lentini

  4. Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy

    Massimiliano Veroux

  5. Nephrology and Dialysis Unit, University Hospital of Catania, Catania, Italy

    Pasquale Fatuzzo

  6. Nephrology and Dialysis Unit, “Santa Maria della Consolazione” Hospital, Rovigo, Italy

    Fulvio Fiorini

  7. Via F. Paradiso n°78/a, 95024, Acireale, CT, Italy

    Antonio Granata

Authors
  1. Antonio Granata
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  2. Pierpaolo Di Nicolò
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  4. Monica Insalaco
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  6. Massimiliano Veroux
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Corresponding author

Correspondence to Antonio Granata.

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Granata, A., Di Nicolò, P., Scarfia, V.R. et al. Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do. J Ultrasound 18, 109–116 (2015). https://doi.org/10.1007/s40477-014-0118-1

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  • DOI: https://doi.org/10.1007/s40477-014-0118-1

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