1.4 Renal Transplants

Question 1

Renal transplants are standard treatment for?

Answer 1

Chronic renal failure

Question 2

What is the term for kidney transplanted from one human to another?

Answer 2

Renal Allograft

Question 3

Kidney can be harvested from (2)?

Answer 3

1. living doner

2. brain dead donor

Question 4

What is another name for a brain dead donor?

Answer 4

Cadaveric donor

Question 5

Where are the transplanted kidneys placed?

Answer 5

Iliac Fossa
between the peritoneum and the iliacus muscle
(more superficial)

Question 6

What happens to the native kidneys?

Answer 6

left in place

Question 7

In long term Dialysis pateints the native kidneys are prone to?

Answer 7

Cysts and neoplasms

Question 8

Allograft ureter is passed ___________ thru the muscular layer of the bladder

Answer 8

obliquely

Question 9

What does the Allograft ureter form?

Answer 9

Non-refluxing UV junction

Question 10

How is the allograft vein is anastomosed?

Answer 10

End to side with the iliac vein

Question 11

Allograft artery has One or Many ways of being attached?

Answer 11

Many

Question 12

Do transplanted kidneys look similar or different to native?

Answer 12

Similar

Question 13

Post transplant kidneys may appear more___________ due to lack of attenuating structures over them

Answer 13

echogenic

Question 14

Allograft usually _________ over period of months following transplant

Answer 14

Enlarges (up to 30%)

Question 15

What could the enlargement of the kidney be mistaken for?

Answer 15

Rejection

Question 16

Slight dilatation of the collecting system is called ____ and is common in allograft

Answer 16

Hydronephrosis

Question 17

When should a baseline study be done after operation

Answer 17

Within 72 hours

Question 18

List the Complications of Renal transplant (7)

Answer 18

1. Rejection
2. Acute Tubular necrosis
3. Av Fistula
4. Arterial Stenosis
5. Perigraft Fluid
6. Pseudoaneurysm
7. Venous/Arterial Thrombosis

Question 19

Should rejection be diagnosed Sonographically?

Answer 19

No

not unless several rejection related abnormalities are present

Question 20

What will rejection waveforms look like?

Answer 20

High resistance

with minimal to absent diastolic flow

Question 21

What will the rejection RI be ?

Answer 21

> /= 0.7 is abnormal

Question 22

Acute Tubular necrosis is a post surgical response resulting from?

Answer 22

Ischemia

Question 23

Acute Tubular Necrosis does not usually alter Doppler BUT an increase in ______ could be seen

Answer 23

PI (pulsatility index)

Question 24

What are examples of perigraft fluid (4)

Answer 24

1. Seromas
2. Hematomas
3. Abscessess
4. Urinomas

Question 25

What does color doppler help detect in these collections?

Answer 25

Active bleeding

Question 26

AV fistula often occurs from?

Answer 26

Biopsy Trauma

Question 27

AV fistula are commonly symptomatic or asymptomatic?

Answer 27

asymptomatic

Question 28

AV fistula may be associated with?

Answer 28

Sustained hypertension

Question 29

AV fistula appears as a __________spot in the renal ______ due to its ________ flow.

Answer 29

Bright; parenchyma; disturbed

Question 30

High velocity flow in the ______ artery with a visible Color Doppler_____

Answer 30

Feeder artery; bruit

Question 31

How common are venous/arterial thrombosis in transplants (%)?

Answer 31

< 1%

Question 32

How soon do venous/arterial thrombosis happen if they do?

Answer 32

immediately post operation

Question 33

What do venous/arterial thrombosis look like on 2D (3)?

Answer 33

1. enlarged kidney 2. distended renal vein 3. absent flow signals in renal vein/artery

Question 34

What is the most common vascular complication occurring in transplanted patients?

Answer 34

Arterial stenosis

Question 35

What percentage of Arterial stenosis occurs in transplanted patients?

Answer 35

10 %

Question 36

Where does the Arterial stenosis usually occur ?

Answer 36

at the anastomosis

Question 37

What is the Arterial stenosis usually due to?

Answer 37

Surgical issues

Question 38

Do older or newer transplants have long segment stenosis?

Answer 38

Older

Question 39

What is the long segment stenosis due to? (2)

Answer 39

1. Scarring or 2. Hyperplasia

Question 40

Doppler shows ______ velocity in the stenotic segment post stenotic turbulence and distal _____ with severe stenosis

Answer 40

Increased; dampening