Renal Artery Stenosis in Living Donor Kidney Transplantation: A Rare Cause of "Flash Edema".

Autor: Fraga Dias B; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal. Electronic address: brunodias.nefrologia@chporto.min-saude.pt., Marques R; Nephrology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal., Faria V; Nephrology Department, Centro Hospitalar Vila de Gaia/Espinho, Vila Nova de Gaia, Portugal., Domingues P; Nephrology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal., Ribeiro C; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal., Silvano J; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal., Malheiro J; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal; UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal., Almeida M; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal; UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal., Pedroso S; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal; UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal., Martins S; Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal; UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2024 Jun; Vol. 56 (5), pp. 1055-1058. Date of Electronic Publication: 2024 Feb 13.
DOI: 10.1016/j.transproceed.2024.01.008
Abstrakt: Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplantation, with an incidence ranging from 1% to 23%. TRAS often presents with clinical features such as refractory hypertension, de novo hypertension, allograft dysfunction, and the presence of a bruit over the graft. A rare manifestation of TRAS is flash pulmonary edema. Here, we present a case of a 37-year-old male who received a living donor kidney. Four years after the transplant, he presented with acute kidney injury, hypertensive crisis, and flash pulmonary edema. Initially, methylprednisolone pulses were administered due to suspicion of acute rejection, which was later ruled out after a kidney graft biopsy. Computed tomography angiography showed findings suggesting stenosis or thrombus in the renal artery. The patient developed sudden acute pulmonary edema, requiring hemodialysis, with notable clinical improvement. Subsequently, stent placement was performed without complications, resulting in the complete recovery of renal function and effective blood pressure control. The incidence of renal artery stenosis is higher in living donor kidney transplantation, mainly due to technical complexities during surgery. Acute presentations, such as flash edema, are exceptionally rare but can occur years after transplantation. Prompt intervention can lead to favorable outcomes.
Competing Interests: Declaration of competing interest All the authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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