0:00

This patient is about 10 days out from a renal

0:03

transplant and provided history delayed graph

0:06

function. So it's not quite perked up

0:09

as it was supposed to post renal transplant into an ultrasound

0:12

was done to evaluate it.

0:14

And here we see it placed in the right lower quadrant measuring about 10.5 centimeters.

0:17

There's good color flow throughout the transplanted kidney.

0:20

There's a few collections seen inferior to it.

0:23

These ones are pretty small.

0:26

There's a collections that are seen in the anterior abdominal wall. Well, this

0:29

one's a rather large. But again, this is separate from the kidney and it's

0:32

probably just a hematoma within the anterabdominal wall

0:35

associated with the transplant here. You can see the transplant again

0:38

in the transverse plane nice color flow within it.

0:41

Then we have to start interrogating the vessels inside the renal

0:44

transplant.

0:45

And first fossil, we interrogators to segmental artery

0:48

in the upper pull. What do we see good sharp systolic

0:51

up strokes and absolutely no diastolic flow

0:54

these sort of waveforms in the background are just

0:57

Venus contamination that we see but the actual diastolic flow

1:00

is essentially non-existent in this patient.

1:03

And we interrogate other areas in interloper arteries

1:06

in the upper pull again, no diastolic flow. And essentially there's

1:09

no diastolic flow. The resistant to the next is going

1:12

to be one which is very very high, you know

1:15

anything about 0.8.

1:17

Makes us worried in these renal transplant patients. We do

1:20

interrogate the veins the veins look okay again, as

1:23

we go to the interloper arteries, you know, this is just venous contamination.

1:26

You don't really see any diastolic flow.

1:29

Segmental arteries now in the lower pole no diastolic

1:32

flow here and just this background venous contamination.

1:35

And so what you're really dealing with now is a

1:38

patient who is delayed graph function for the clinical history and situation

1:41

where the internal vessels

1:44

within the renal transplant have extremely high

1:47

vascular resistance. There's a number of ideologies for

1:50

this certainly a cute tubular necrosis can

1:53

look like this. But remember Q tubular across is typically occurs within

1:56

the first three days of the renal

1:59

transplant three to four days. This patients at around

2:02

post-op day 10, certainly q-tulative courses could

2:05

occur in the setting but most likely at this

2:08

time from the renal transplant more often.

2:11

It's going to be to acute rejection. This has

2:14

been reported to corrupt to about 40% of patiently transplants.

2:17

Although the incident has decreased you

2:20

to Improvement in new, you know, suppressant regimens, as

2:23

I said it incur about a week to three weeks out post real

2:26

translation you're looking for

2:29

You know, you can suggest the diagnosis. This is what you see on

2:32

Imaging But ultimately to make the diagnosis you do need to do a biopsy.

2:36

Treatment varies from including steroid treatment or

2:39

increasing the immunosuppression and if it's very

2:42

very severe acute rejection can cause in fact

2:45

reverse diastolic flow as well. And so that's something to think about if

2:48

you also have very very severe acute rejection. And

2:51

so this case nicely showcases, you know,

2:54

a kidney with internal vessels with extremely high

2:57

resistive indices of essentially one and in the setting

3:00

around post-op day 10 for menial transplant. This is

3:03

most likely due to acute rejection.