An evaluation of technetium-99m tin colloid--its value in the diagnosis of renal transplant rejection.

The value of the Technetium-99m tin colloid (TTC) scan in the diagnosis of renal transplant rejection occurring more than 1 month following transplantation was assessed. To our knowledge, use of this agent has not previously been reported. Gamma camera imaging was performed on 15 occasions in 14 patients in whom plasma creatinine was rising and in three patients in whom renal function was stable. Both a qualitative and a quantitative assessment of images was made. The radioactivity recorded over the graft at 12-16 min post injection was expressed as a percentage of that recorded at 0-4 min. In the nine patients in whom graft perfusion was adequate to allow interpretation of the TTC scan and in whom rejection was diagnosed by biopsy (six cases) or on clinical grounds (three cases), the index ranged from 45 to 153%. In two patients the graft was poorly perfused and the accumulation of TTC was predictably low despite the presence of rejection. In the seven patients with either a stable creatinine or with rising creatinine not due to rejection, the index ranged from 5 to 43%. Previously reported studies have shown that sulphur colloids may be of value in diagnosing graft rejection. This study suggests that Tc99m tin colloid may be regarded as a suitable alternative scanning agent and that some simplification of data collection and analysis can be achieved.

Temporary loss of renal function: an unusual complication of perinephric hemorrhage after percutaneous renal biopsy.

Two cases of temporary loss of function following percutaneous renal biopsy are reported. The mechanism was probably restriction of renal perfusion brought about by the compression of the perirenal hematoma.

Right atrial ball thrombus as a complication of subclavian catheter insertion for hemodialysis access.

In two patients right atrial ball thrombi developed following prolonged subclavian cannulation for hemodialysis. One patient died, the other had the ball thrombus removed by open heart surgery. It appears that repeated friction of the catheter tip may have damaged the endothelium of the right atrial wall. This hitherto unrecognised complication might be prevented by ensuring that subclavian hemodialysis catheters are never allowed to reach as far as the right atrium.

Evaluation of the intact hormone assay in the study of parathyroid autograft function.

Parathyroid autograft function was studied using radioimmunoassay measuring intact parathormone (iPTH) and C-terminal PTH (C-PTH). Blood samples were taken from graft and non-graft arms pre- and post-dialysis. The intact assay showed an appreciably greater differential gradient pre- and post-dialysis than the C-terminal assay. We conclude that particularly in patients with chronic renal failure the intact assay is of greater value in monitoring graft function than the commonly used C-terminal assay. It may also be of value in distinguishing between graft overactivity and ectopic cervical parathyroid tissue in cases of recurrent hyperparathyroidism following apparently total parathyroidectomy and autotransplantation.