Acute renal allograft dysfunction in the setting of deep venous thrombosis: a case of successful urokinase thrombolysis and a review of the literature.

Acute renal allograft vein thrombosis is a rare but serious complication of renal transplantation. When occurring in the early posttransplant period it is usually associated with surgical complications and often results in the loss of the graft. At later stages, when graft function has stabilized, its development may then be associated with underlying disorders such as glomerulonephritis, immunosuppressive therapy, increased hematocrit, acute rejection, or extension of lower extremity venous thromboses. We report a case of acute allograft dysfunction occurring in the setting of extensive deep vein thrombosis. In our patient, thrombosis in the setting of acute graft tenderness and swelling, anuria, and an increasing creatinine strongly suggest a diagnosis of acute allograft renal vein thrombosis. We describe a successful reversal of acute renal failure through urokinase thrombolysis and review the current literature on the use of thrombolytic agents for the treatment of acute renal allograft vein thrombosis.

Acute renal failure following intravenous use of radiographic contrast dyes in patients with diabetes mellitus.

Acute renal failure following roentgenologic procedures employing intravenous administration of contrast media was observed in seven diabetic patients over an 18-month period. All had long-standing diabetes mellitus complicated by retinopathy and cardiovascular disease; six had mild impairment in renal function before x-ray studies. The renal failure occurred within 48 hours of the procedure and was of the oliguric type in six of the patients. Renal function returned toward the prestudy levels within four weeks. None of the patients required dialysis. Combined analysis of our data and those of 31 cases reported in the literature suggest that certain factors in diabetic patients make them prone to develop dye-induced acute renal failure: These include old age; long duration of diabetes; preëxisting impaired renal function; the presence of diabetic complications such as retinopathy, neuropathy, and cardiovascular disease; and dehydration. All diabetic patients should be monitored closely after a radio-contrast study to detect the development of acute renal failure so that appropriate management can be instituted early in the course of the disease.