Risk factors of transplant renal artery stenosis in kidney transplant recipients

Abstract Background: Transplant Renal Artery Stenosis (TRAS) is a recognized vascular complication after kidney transplantation. The overall risk predictors of TRAS are poorly understood. Methods: Retrospective analysis of patients with suspected TRAS (Doppler ultrasound PSV > 200 cm/s) who underwent angiographic study in a single center between 2007 and 2014. All patients with stenosis > 50% were considered with TRAS. Stenosis restricted in the body of the artery was also analyzed in a subgroup. Results: 274 patients were submitted to a renal angiography and 166 confirmed TRAS. TRAS group featured an older population (46.3 ± 11.0 vs. 40.9 ±14.2 years; p = 0.001), more frequent hypertensive nephropathy (30.1% vs. 15.7%; p = 0.01), higher incidence of Delayed Graft Function (DGF) (52.0% vs. 25.6%; p < 0.001) and longer Cold Ischemia Time (CIT) (21.5 ± 10.6 vs. 15.7 ± 12.9h; p < 0.001). In multivariable analyses, DGF (OR = 3.31; 95% CI 1.78-6.30; p < 0.0001) was independent risk factors for TRAS. DM and CIT showed a tendency towards TRAS. The compound discriminatory capacity of the multivariable model (AUC = 0.775; 95% CI 0.718-0.831) is significantly higher than systolic blood pressure and creatinine alone (AUC = 0.62; 95% CI 0.558-0.661). In body artery stenosis subgroup, DGF (OR = 1.86; 95% CI 1.04-3.36; p = 0.03) and Diabetes Mellitus (DM) (OR = 2.44; 95% CI 1.31-4.60; p = 0.005) were independent risk factors for TRAS. Conclusion: In our transplant population, DGF increased more than 3-fold the risk of TRAS. In the subgroup analysis, both DGF and DM increases the risk of body artery stenosis. The addition of other factors to hypertension and renal dysfunction may increase diagnostic accuracy.

Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.

Establishment of normal reference of radiological morphology of renal artery in mini-pigs by renal angiography

Mini-pigs have been widely employed in preclinical studies to explore new therapeutic strategies for diseases of the human urinary system; however, the normal reference of the renal artery has not been clearly investigated in the mini-pig model. Therefore, we aimed to establish a normal reference of the radiological morphology of the renal artery in mini-pigs by renal angiography via catheterization of the carotid artery. The renal angiographies obtained from 15 mini-pigs were evaluated to determine the orifice from the aorta, facing direction, size and the number of branches of renal arteries. Cranio-laterally facing renal arteries with 2 distal branches were mainly observed in the renal artery of mini-pigs. Both sides of the renal artery presented symmetrical sizes; however, the right renal artery orifice from the aorta was located more cranially than the left counterpart. The results of this study will contribute to radiological diagnosis of the renal artery as well as preclinical studies of mini-pigs.

Avaliação da técnica de arteriografia renal guiada por fluoroscopia em suínos / Description of the fluoroscopy-guided renal arteriography in swine

The fluoroscopy-guided renal arteriography was evaluated in order to be used as an auxiliary method in investigations and as a way to experimentally induce kidney diseases in swine. The technique was effective to obtain sharp images as well as to determine the area of renal irrigation. Despite its easiness, trained professionals are required to perform it.

Selective renal artery angiography and embolization for nephrorrhagia diseases / 中国介入影像与治疗学

Objective To assess the value of selective renal arteriography and embolization in the therapy of nephrorrhagia diseases.Methods Fifteen patients of renal hemorrhages including 10 iatrogenic renal trauma,3 renal harmatoma and 2 renal closed injury with ineffective medical treatment underwent selective renal artery embolization.Results Renal artery an-giographies confirmed renal segmental arteries and/or their branches injuries.Gelatin sponge,PVA or steel coil were used for embolization.During 1-3 months fllowing-up,renal abscess was found in 2 patients without superselective embolization,while haematuria occurred in one case after embolization with gelatin sponge but stopped after medical treatment.The renal function of all patients were normal after embolization.Conclusion Superselective renal artery embolization has reliable effect and slight complication in the treatment of nephrorrhagia,especially suitable for patients after surgery and renal inadequacy.

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization.

Emergent endovascular embolization of iatrogenic renal vascular injuries / 介入放射学杂志

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

Renal Pseudoaneurysm after Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Renal hemorrhage is a most distressing complication of percutaneous renal surgery. Two cases of renal pseudoaneurysm that occurred as a complication of percutaneous nephrolithotomy (PNL) for staghorn calculi are presented. Two male patients were admitted to our hospital for treatment of staghorn calculi. Laboratory data on admission revealed no significant abnormality. They underwent PNL, and most of the calculi were removed. Two nephrostomys were placed in the middle and lower calyces, and were removed at two and three days postoperatively, respectively. Significant bleeding, uncontrolled by the usual measures, developed for six and eight days following the removal of the nephrostomy tubes. Renal angiography was performed and demonstrated pseudoaneurysms. At the same time the pseudoaneurysms were treated by superselective embolization with a coil. We keep in mind the late hemorrhage after PNL, even when there was no hemorrhage from nephrostomy removal.

Carcinoid Tumor Arising from Horseshoe Kidney: Report of Two Cases

Primary carcinoid tumor of the kidney is a very rare neoplasm. In the literature 41 cases have been reported to date, and nine of these occurred in a horseshoe kidney. We report two cases of carcinoid tumor arising from horseshoe kidney, together with the radiological findings.

The Value of Angiography with Adrenalin in Diagnosing Renal Tumour / 实用放射学杂志

Objective To evaluate diagnostic significance of renal arteriography by injecting adrenalin in patients with renal tumour.Methods The renal angiography after administration of adrenalin (6 ?g) in 47 patients with renal malign ant tumour were performed.The angiographic results were analysed in comparison with that of pathology.The diagnostic accuracy parameters including sensitivity,specificity,accuracy,positive prediction rate,negative prediction rate,positive and negative index were caluclated.Results The sensitivity, specificity and accuracy in the detection of renal malign ant tumour were 93% ,94% and 94% respectively. Positive prediction rate were 97%,negative prediction rate was 89%, positive likelihood rate was 15.8, negative likelihood rate was 0.07 and Youden index was 0.87.Conclusion Medicaments angiography by injecting adrenalin is of important diagnostic value for renal tumour,especially for those which are vascularized and could not diagnosed by other technology qualitatively.

The variations of the renal segments in Korean adults / 대한비뇨기과학회지

To investigate the variations of the renal segments in Korean adults. the findings of selective renal arteriograms from l3O kidneys were analyzed. The boundary on the lateral surface of the kidney between the areas supplied by anterior and posterior branches of the renal artery was investigated by analysis of the findings of 100 renal arteriograms. In 75% of the cases the boundary was observed to be posterior to the lateral borderline of the kidney and the configuration of it was variable. Under the definition of the segmental artery as the eecorrd branch of the renal artery that could be tied outside the hilum, the distribution of the renal segments was observed. The number of the renal segments in a kidney ranged from 3 to 7 and the frequency was 1.6%. 24.2%. 50.8%. 22.6% and 0.8% in the order of increment. The 5-segment-kidney, the most common form described in many textbooks, was observed in 50.8% of the cases and also was the most common form in this study. In most of the cases(90%) superior and inferior segments were observed. The level of each boundary of the superior and inferior segments was observed on the ventral and dorsal surface of the kidney and compared. The level was identical on both surfaces in 56.1% and 31.8 5t of the superior and inferior segments respectively. The variations in the origin and the number of arteries supplying the superior and inferior segments was compared and the result revealed more complex variations in the former. From the viewpoint of clinical application these results may provide useful information and important suggestions for renal conservative surgery. Considering that the distribution of the renal segments is variable and the number and origin of the arteries supplying the superior and inferior segments, which are frequently indicated for partial nephrectomy. are variable. it may contribute to better surgical results if surgeons observe and decide the resection margin preoperatively by taking the selective renal arteriography from several directions.

Clinical Significance of the Renal Angiography / 대한비뇨기과학회지

Renal angiography is a highly valuable diagnostic procedure for the detection and exact evaluation of various renal disease, especially differentiation of benign and malignant lesions. During the period of January 1978 to December 1983, 39patients who had been taken renal angiography were analysed and following results were obtained. 1. Male to female ratio of performing renal angiography was approximately 1:1 and peak incidence was fifth decade. 2. Indication of renal angiography was renal mass, abnormal I.V.P. and R.G.P., renal bleeding, kidney donor, hypertension, in order of its frequency. 3. The most frequent diagnosis encountered was renal cell carcinoma (15 cases), diagnostic accuracy of renal angiography was 93.3%. 4. Arterial embolization of renal cell carcinoma was tried in 2 cases preoperatively, and it was found that this was a valuable method in reducing blood loss, in performing operation.

Clinical Significance of the Renal Angiography / 대한비뇨기과학회지

Renal angiography has applications in the diagnosis of renal tumor and renovascular hypertension, and provides important anatomical information that can influence the surgical management. Recently the approach to the vascular system for diagnosis by means of Seldinger technique hag been expended to include a variety of therapeutic manner. So, embolization of renal carcinoma is being used with increasing frequency. Radiologic findings associated with presenting symptoms and signs were analysed in 51 cases of renal angiography, during the period of October 1978 to October 1982. The following results were obtained. 1. Male to female ratio was approximately 1:1 and peak incidence was in the sixth decade. 2. The main symptoms and signs of patients were hematuria, flank pain, hypertension and palpable mass, in order of frequency. 3. In 7 hypertensive patients with delayed visualization on the excretory urogram. angiography shows 2 cases of renal artery stenosis, one case of Takayasu's disease and absence of abnormal vasculature in 4 cases. 4. It is suggested most valuable technique for correct diagnosis of renal vascular disease. some of other congenital anomalies, and renal vascular mapping for renal surgery.

Role of Renal Angiography in The Era of Ultrasonography and CT / 대한비뇨기과학회지

Role of renal angiography in the diagnosis of renal disease is changing after the advent of new imaging techniques such as ultrasonography and CT. Ultrasonography and CT examination started to be used clinically on March 1, 1979, in Seoul National University Hospital. Total 315 cases of renal angiography were made for recent 7 years from September 1, 1975 to August 30, 1982, 117 cases in 3 1/2 years before and 198 cases in 31/2 years after the installation of new imaging modalities. To evaluate the changing role of renal angiography, sequential flow patterns of various radiological examination were classified into 7 categories. Results of the analysis were as follows; 1. The increased ratio of renal angiography after the advent of new imaging modalities is 1.7 and slightly less than that of total radiological examinations. 2. The role of renal angiography is decreased in the diagnostic work-up of renal mass, hematuria, adrenal disease, renal failure and other renal evaluation. Angiography has significant role still in the evaluation for renovascular hypertension, renal trauma, transplantation donor, renalvein thrombosis and artificial embolization. 3. The most frequent flow pattern is AII (IVP-Aug) before and BII (IVP-US [CT]-Aug) after the advent of new imaging modalities.

A Clinical Observation on Renal Angiography / 대한비뇨기과학회지

Renal angiogram is a safe and excellent procedure for an early detection and accurate diagnosis of benign or malignant diseases. Selective renal angiography has been used mainly in the diagnosis of surgical disease, but now many informations are available regarding the vascular disease, pyelonephritis and renal tuberculosis. A clinical observation was made on 18 cases of the renal angiography from January. 1978 to June, 1981.

Clinical Observation on Renal Angiography / 대한비뇨기과학회지

Renal angiography is now one of invaluable adjuncts to urologic disease with computed tomography and ultrasonography. Authors observed in 50 cases of renal angiography which performed in the Department of Urology, Kyung Hee University Hospital during the period from September. 1977 to August 1980. In detecting and defining both the presence and extent of renal diseases such as tumor, cyst, injury and vascular disorder, renal angiography is highly reliable and accurate.

A Clinical Observation in Renal Angiography / 대한비뇨기과학회지

There are many radiodiagnostic methods it renal diseases; intravenous pyelogram, retrograde pyelogram, antegrade pyelogram, nephrotomogram and renal angiogram. In recent years, ultrasonogram and computed axial tomogram were developed. They help for early detection and accurate diagnosis of renal disease Abdominal aortogram was described by dos Santos, a Portugese doctor in 1923. It was greatly advanced by Seldinger through his development of percutaneous method of transfemoral catheterization in 1956. Rentl arteriogram is a highly valuable diagnostic procedure. It appears clearly that selective angiography is a safe and excellent procedure for an early detection and accurate diagnosis of benign and maligtant disease In the past, selective renal angiography has been used mainly in diagnosis of surgical disease rather than those medical disease. But now, many information are available regarding the vascular disease, pyelonephritis, glomerulonephritis and renal tuberculosis, particularly with regard to changes in the small renal arteries And it supplied various information for anatomic vascular feature of donor kidney in renal transplantation. The intent of this report is to emphasize usefulness of this procedure in the diagnosis of certain lesion of kidney which was not clearly defined by conventional methods. Radiologic findings associated with conditions and presenting symptoms or signs were analyzed in 97 cases of renal angiogram, during the period of May 1972 to August 1978.

A Clinical Observation of the Renal Angiography / 대한비뇨기과학회지

Renal angiography provides the ultimate in detailed vascularization of the renal vessels and vascular architecture of kidney. It is used in diagnosis and treatment of renal diseases e.g. renal injury, tumor, cyst and inflammation. A clinical observation of renal angiography was made on 49 cases of renal diseases which had been admitted to the Department of Urology, National Medical Center from 1975 to 1979. The diagnostic accuracy of renal angiography was 87.8%.

The Renal Angiography in Blunt Renal Trauma / 대한비뇨기과학회지

19 patients with blunt renal trauma who was checked renal angiography have been studied in the department of urology, national medical center, Catholic medical college and Seoul national university hospital , from Jan, 1976 to May. 1978. The results were followed; 1) Renal angiography was a best diagnostic procedure for a salvage of injured kidney. 2) If I. V. P. slowed abnormal findings in conservative management group, angiography was necessitated for the lesion diagnosed only with angiography. 3) In case of normal I. V. P. with stable vital sign, renal angiography was less helpful for treatment 4) In case of polar rupture and stable vital sign conservative management was more reliable therapy.

A Comparative Study of Excretory Urography and Renal Angiography on Blunt Renal Trauma / 대한비뇨기과학회지

10 patients with blunt renal trauma have been studied and compared by the excretory urography and renal angiography in the Department of Urology, National Medical Center, Seoul, during the period of January 1976 through June 1977. The following results were obtained: 1) Renal angiography is a more specific diagnostic procedure than the excretory urography in detailing the extent of injury. And it provides more opportunity of a high salvage rate of injured kidney. 2) In a normal excretory urography, renal angiography need not do in deciding surgical management of renal injury. 3) The result of positive renal angiograms was especially great in patients showing any of the following urographic abnormalities; non-or poor visualization and extravasation of contrast media. 4) Surgical intervention was done in only one patient of renal thrombosis.