0:00

This is a picture of the rail transplant of rising creatinine.

0:03

And so we're asked to evaluate it initially if some

0:06

images of the bladder followed by the kidney itself. Grayscale. Imaging

0:09

is significant. I suppose for a little bit of hydronephrosis. This

0:12

with a rounded calluses is a little bit more than you'd

0:15

expect.

0:16

We don't see any collections or masses associated with the kidney.

0:19

We're seeing flow throughout the transplanted, kidney.

0:22

But that's not sort of the finding. I want to share with you. You know,

0:25

we can look at certainly the Enterprise vessels you

0:28

all have nice resistive indices. So we're not

0:31

too worried about flow within the renal transplanted kidney itself.

0:35

However, in this instance, the renal vein is

0:38

a little bit interesting in that you could already see on the color Imaging this

0:41

this flow going away from the renal transplant towards the

0:44

external iliac vein relatively normal and then a little

0:47

bit more turbulent flow over here. So maybe there's something going on

0:50

in this location. We start interrogating those regions. We can

0:53

see here an acceptable velocity of about 24

0:56

centimeters per second here about 24. So in

0:59

good shape while we get to that area of turbulent flow.

1:03

We jump all the way up to 273.

1:07

And so that is extremely extremely high over there.

1:11

Here we're interrogating the main renal artery

1:14

and now we're back valuing the venous system the

1:17

venous system and the external pain is about 43 and so

1:20

really anastomosis is about 211. So

1:23

a little bit elevated there, but really as we're in sort

1:26

of the mid portion to an astimosis portion of that renal

1:29

vein, the velocities are very very high. And so, you know,

1:32

the only way one could sort

1:35

of interpret it based on the Imaging is that there are some degree of greenal veins

1:38

stenosis. Now, it does turn out that renal means

1:41

stenosis is very very rare. So I would caution anyone to make that

1:44

diagnosis you can sometimes see if there's external compression

1:47

and perhaps the kidney is placed in

1:50

such a way in the pelvis. It's that there's some kinking of

1:53

that renal vein and there's no sort of set Imaging criteria

1:56

that are established to diagnose this

1:59

you surely just have to look at the renal vein. Look for narrowing

2:02

on grayscale Imaging look for

2:04

Quite a jump of elevated velocities which in

2:07

this case goes from about 20 to 270 and

2:10

that could suggest that there are some degree renal veins

2:13

stenosis this in fact resolved in this patient.

2:16

We didn't really know why this was so elevated perhaps at

2:19

the time. It was image the kidney was placed in a

2:22

certain way that allowed this area to be kinked a little bit resulting in

2:25

elevative velocities, but this had resolved upon subsequent ultrasounds.