Summary
Posttransplant renal artery stenosis (TRAS) as a cause of secondary hypertension is reported with an incidence of 1 to 10%. Early diagnosis of TRAS should be made by non-nephrotoxic and non-invasive means to lower the risk of hypertension. One to 66 months after kidney transplantation 335 patients underwent Duplex-scanning, 38 of cases for clinical tentative diagnosis of TRAS. Parameters for clinical diagnosis of TRAS were diastolic hypertension > 100 mm Hg with resistance to therapy (A), an abdominal bruit over the transplant (B), disturbance of renal function (serum-creatinin > 2 mg/dl) (C). Admission to study followed the parameter-combination A + B, A + C, B + C. Rejection crisis was excluded in 18/38 cases by fine needle biopsy, cyclosporine over-dosage was negative in 38/38 cases, 20/38 cases had normal renal function. Duplex-/Doppler-ultrasound criteria for TRAS were systolic peak velocity > 100 cm/s−1 and broadening of the diastolic frequency spectra with a smooth decline in diastole to an elevated diastolic level. In 32/38 cases (84.2%,n=38) diagnosis of TRAS was made by duplex-scanning, angiography confirmed the result in 30/32 cases (93.75%,n=32); sensitivity was 88.2% with a specifity of 66.6%. Duplex-scanning as a primary diagnostic means for TRAS seems a promising method compared to e.g. radionuclide imaging or angiography. Duplex-scanning is a non-nephrotoxic and non-invasive procedure repeatable at any time with only few preliminary conditions. Moreover, Duplex-scanning can be used as a screening method in ambulant graft-care in observation of the clinical course after PTA or desobliteration. So graft-recipient and organ prognosis could be improved by early diagnosis of TRAS and adapted antihypertensive medication.
Zusammenfassung
Transplantatnierenarterienstenosen als Ursache einer sekundären Hypertonie werden mit einer Inzidenz von 1 bis 10% beschrieben. Eine frühzeitige Diagnose ist wünschenswert, um das Hypertonie-Risiko zu senken. 1 bis 66 Monate nach Nierentransplantation wurden 335 Patienten mittels Duplex-Sonographie untersucht. Klinisch bestand Verdacht auf Transplantatnierenarterienstenose in 38 Fällen. Parameter waren (A) therapieresistente diastol. Hypertonie > 100 mm Hg, (B) Strömungsgeräusch über dem Transplantat, (C) Kreatininspiegel > 2 mg/dl. Zulassung zur Untersuchergruppe erfolgte bei Parameterkombination A + B, A + C, B + C. Duplex-/Doppler-sonographische Parameter für Stenosen waren eine maximale systolische Strömungsgeschwindigkeit > 100 cm/s−1 und Verbreiterung des Frequenzspektrums mit langsamerem Abfall der Diastole zu einem angehobenen diastolischen Niveau. In 32/38 Füllen wurde eine Transplantatnierenarterienstenose Duplex-sonographisch ermittelt und angiographisch in 30/32 Fälle (93,75 %,n = 32) bestätigt. Wir ermittelten eine Sensitivität von 88,2%, bei einer Spezifität von 66,6%, für die Duplex-Sonographie. In der Diagnostik von Transplantatnierenarterienstenosen ist die Duplex-Sonographie gegenüber Angio- oder Szintigraphie eine vielversprechende Alternative als primäres Untersuchungsverfahren. Das Verfahren ist nicht invasiv, nicht nephrotoxisch, problemlos wiederholbar und die Zahl falsch negativer Ergebnisse im Vergleich zur Szintigraphie geringer. Duplex-Sonographie kann als Screening-Verfahren und zur Therapieverlaufskontrolle nach Angioplastie oder Gefäßrevision eingesetzt werden. Die Prognose von Nieren-transplantaten könnte sich durch frühzeitige Diagnostik und adäquater antihypertensiver Therapie mit duplexsonographischer Verlaufskontrolle langfristig verbessern.
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Winde, G., Buchhol, B., Krings, W. et al. Duplex-Sonographie in der Diagnostik von Nierenarterienstenosen nach allogener Nierentransplantation. Langenbecks Arch Chiv 374, 284–290 (1989). https://doi.org/10.1007/BF01261471
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DOI: https://doi.org/10.1007/BF01261471