[Evaluation of gray scale sonography and Doppler sonography findings in patients with renal transplant rejection]

This study was conducted to compare the sonographic [gray scale] findings with those of Doppler sonography in patients with rejection of kidney transplant. This was a cross-sectional study performed in Hasheminejhad Educational and Therapeutic Center in Tehran. Sonography and then Doppler sonography were performed and primary creatinin level and if needed sequential creatinin levels, were checked. We used a scanner [AU4 mod] with 3.5 and 7.5 MHz probes. The most common morphologic signs in sonography were increased antro-posterior diameter of allografts in 19 cases [31.4%]. Other common morphologic signs consisted of increased cortical echogenicity in 18cases [30%], increased prominanance of the renal pyramid or hypoechogenicity of pyramid in 12 cases [20%], decreased echogenicity of rejected kidney sinus in 7cases [11/7%]. The rarest morphologic sign was focal cortical hypoechogenicity in 2cases [3/4%]. Thirty one patients [51.7%] had positive sonographic findings, 47 patients [78/3%] had Resistive Index [RI] >/-0.8 and 13 patients [21/7%] had Resistive Index>/-0.9. Those with age range of 51-65 years had the highest frequency among all the patients and revealed positive findings in both methods of sonography. In 23.4% of the patients creatinin level was normal. 46 patients [76.6%] had early and fourteen other patients had late onset rejection of the transplant. Doppler sonography [RI] is the best and most sensitive non invasive method for precise and early diagnosis of renal allograft rejection. RI>/-.0.8 has eliminated need of taking biopsy. Findings of sonography were less sensitive than those of Doppler sonography

[Renal transplantation in children with cystinosis]

Cystinosis is an inherited metabolic disease in which transfer of cystine out of lysosome is impaired. This phenomenon leads to accumulation of cystine in different organs and causes organ dysfunction. Growth retardation is seen in these patients and later they go on to develop renal failure needing dialysis or renal transplantation. The aim of this study was to evaluate the outcome and complications of renal transplantation in patients with cystinosis. In this case series study in years 1996-2006 all patients with renal failure due to cystinosis who received renal transplantation, were followed for 43 +/- 1/1 months, Before operation, all patients were examined to determine if they are appropriate candidate for renal transplantation and after operation DPTA scan was performed to evaluate graft function and in later follow up necessary lab tests were done. All patients received triple immunosuppressive therapy including cyclosporine, prednisolone and Mycophenolate Mofetil. In the presence of rejection symptoms such as fever and a rise in creatinine, graft rejection was confirmed by DPTA scan and sonography of transplanted kidney. Patient survival was 100% and 4 years graft survival was 86.7%. Mean creatinine level before operation was 5.44 +/- 2.58 and post operation was 0.86 +/- 1.03 and at the last follow-up was 1.51 +/- 1.45 mg/dl, mean GFR at the last follow-up was 54.1 +/- 31.2 ml/min/1.73m2. Six [40%] patients were on dialysis before operation, 5 [33%] had acute rejection and 5 [33%] suffered from UTI after the operation. Growth retardation was seen in all of patients. Thirteen patients [86%] were affected by CMV infection and 6 [40%] by CMV disease; that were treated successfully by Ganciclovir for 2 weeks. One patient was affected by vessel thrombosis in post operation period and one patient had graft loss due to kink of vessel after operation. Renal transplantation in patients with cystinosis has favorable outcome. It is the treatment of choice for patients with cystinosis and End Stage Renal Failure [ESRF]