Peculiarities of clinical and instrumental presentation of transplant renal artery stenosis in a patient with chronic humoral graft rejection

Vascular complications after renal transplantation occur with an incidence of 5% to 10%. Among them, transplant renal artery stenosis (TRAS) is the most common (up to 75%). The basic clinical and instrumental features of formed TRAS are refractory arterial hypertension (AH) and progressive kidney transplant (KT) dysfunction. Well-timed surgical correction of TRAS resulted in significant regression of renal transplant dysfunction and led to stabilization of the patient’s condition. The procedure of choice is percutaneous transluminal angioplasty (PTA) including balloon angioplasty and direct stenting of transplant renal artery (TRA). A clinical case of rapidly progressing allograft dysfunction in a patient with stable blood pressure is presented. Among possible causes of KT dysfunction, an accidental overdose of calcineurin inhibitors was excluded. Initially, TRAS as a possible cause of allograft dysfunction was not discussed. Color Doppler ultrasound of KT was performed within the diagnostic search. Direct Doppler signs of distal TRAS and multiple stenoses of segmental arteries were detected. Obtained data were confirmed by CT-scan angiography: severe TRAS (more than 85%) and multifocal atherosclerotic lesion of segmental arteries were diagnosed. After that PTA with TRA stenting was performed. KT function significantly improved in the early postoperative period and remained stable during the entire observation period. Successful PTA and active nephroprotective support before repeated contrast media introduction ensured KT safety prevented the start of hemodialysis. The patient was included in transplant list. Correct interpretation of peculiar doppler sings of TRAS in the absence of AH in a patient with rapidly progressing allograft dysfunction allowed to choose the right diagnostic search and optimal treatment strategy.

трансплантация почки, стеноз почечной артерии трансплантата, дисфункция почечного трансплантата, атеросклеротическое поражение почечной артерии трансплантата, цветовое дуплексное сканирование, kidney transplantation, transplant renal artery stenosis, kidney graft dysfunction, atherosclerotic disease, color doppler ultrasound

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