0:00

This is a patient who had a real transplant about

0:03

six years prior to this Imaging study.

0:06

There were metrics suggesting. The transit wasn't

0:09

working very well. And so in ultrasounds obtained to evaluate it

0:12

we start off looking at this trance

0:15

Center of grayscale Imaging and it's placed in

0:18

the right lower quadrant as most transplants are and looks reasonably. Well on

0:22

the gray skill limit itself the measures about 11.7 centimeters.

0:26

I'm not seeing any masses. No obvious collections.

0:29

There's a little bit of fullness of the collecting system

0:32

that degree is probably acceptable.

0:35

we do see color images suggesting that there's flow

0:38

in this renal transplant and

0:41

when we start to interrogate some of the vessels there

0:44

is Venous flow. We look at the real arteries

0:47

segmental upper plovino arteries nice Sharps isolic up

0:50

strokes, but the diastolic flow is quite low that

0:53

anti-stolic velocity of about 3.89 you do

0:56

the math that results in a resistive index of about 0.88. Remember

0:59

anything about 0.8 is

1:02

a little bit too high and suggests that there's some

1:05

degree of increased vascular resistance within this real transplant

1:08

itself. And so we can certainly interrogate other

1:11

regions the interlobal arteries that shows a similar resistance 0.88.

1:16

Here segmental lower pole 0.87 interloball

1:19

here potentially up to one where you

1:22

don't see any diastolic flow.

1:25

So you're sort of looking around the kidney in

1:28

and everywhere you're interrogating those residencies are quite high point

1:31

eight eight point eight seven up to one. So there's

1:34

something going wrong with the kidney and it's

1:37

not functioning properly.

1:38

Given the time frame in which we're observing this

1:42

this patient how to transplant about six years ago.

1:45

Possibilities are one of two either chronic rejection

1:48

or potentially drug toxicity.

1:51

And the Imaging appearance of those will be quite

1:54

similar and the time frame which they occur will be quite similar and

1:57

it's going to be tough to sort of figure that out based on

2:00

Imaging those ideologies are amongst the most common

2:03

cause of late graft loss and

2:06

it's defined really is deterioration of the

2:09

renal function which occurs at least three months post-surgery in

2:12

the absence of any other causes that you can

2:15

figure out for the craft loss.

2:17

As I said, you know chronic rejection can

2:20

look like this and I said drug toxicity and

2:23

the drugs were talking about unfortunately are some

2:26

of the drugs that can also be used in the renal transplant immunosuppressive

2:29

regimen so those drugs itself can sometimes

2:32

cause nephrotoxicity that's one of the side effects and

2:35

so the patient is unlucky that may occur as well.

2:38

And so the Imaging appearance is basically going to

2:41

be a kidney with extremely high resistive indices. And again,

2:44

you just have to sort of figure out when this is occurring if

2:47

it occurs within the first say three days this ideology

2:50

will be most likely to tubular necrosis. If it

2:53

occurs within the first three weeks, it's probably going to be acute rejection

2:56

that occurs after three months probably going

2:59

to be chronic rejection. And if the

3:02

patient is been on medications for a long period of

3:05

time for the immunosuppressant and you see these findings then potentially this

3:08

could be related to drug toxicity.