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Paper Information

Title: 

"DUAL EFFECT OF STEAL SYNDROME AND RENAL VEIN BACK FLOW IN AN ALLOGRAFT KIDNEY DUE TO IPSILATERAL FEMOROSAFENOUS A-V FISTULA. A CASE REPORT"

Type: PAPER
Author(s): MEHRABAN DARAB,NADERI GHOLAMHOSSEIN,TAFTACHI AHMAD REZA*,KEYHAN HOSSEIN,SOFIKERIM MUSTAFA
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

PROPOSE: RENAL GRAFT VASCULAR STATUS AND HEMODYNAMICS ARE ONE OF THE MOST IMPORTANT ISSUES IN GRAFT FUNCTION AND SURVIVAL. DETECTION AND CORRECTION OF ANY DETORIATION SHOULD BE CONSIDERED PROMPTLY.
METHODS & MATERIALS: CASE REPORT: OUR CASE IS A 14 Y.O. MALE WHO UNDERWENT RENAL TRANSPLANTATION FROM CADAVERIC DONOR INTO HIS LEFT ILIAC FOSSA. HIS PAST MEDICAL HISTORY REVEALED THAT HE HAD ACUTE BACTERIAL MENINGITIS WHEN HE WAS 6 M.O. AND SUBSECUENT URINARY AND BOWEL INCOTINENCE. HE HAD UNDERGONE ILEOCYSTOPLASTY+RIGHT SIDED URETERONEOCYSTOSTOMY+APPENDICOCYSTOSTOMY FOR HIS HIGH PRESSURE NEUROGENIC BLADDER AND BILATERAL GRADE IV VESICOURETERAL REFLUX WHEN HE WAS 8 Y.O. THEN HE HAS BEEN FOLLOWED BY CLEAN INTERMITTENT CATETERIZATION 5 TIMES PER DAY FOR 3 YEARS WHEN HE WAS LOST OF FOLLOWING UP. HIS SERUM CREATININ WAS 1.0 MG/DL AT THAT TIME. WHEN HE ADMITTED TO OUR EMERGENCY ROOM 3 YEARS LATER WITH CHILLS, FEVER AND HEMATURIA THE SERUM CREATININ WAS 7.0 MG/DL. ULTRASOUND SHOWED BILATERAL HYDRONEPHROTIC CHRONIC ATROPHIC KIDNEYS. MAG-3 SYNTIGRAPHY ALSO PROVED BILATERAL HYPOFUNCTIONING KIDNEYS WITH PARENCHYMAL ATROPHY. RENAL REPLACEMENT THRAPY WITH HEMODIALYSIS PLANNED FOR HIM. ALL ATTAMPTS FOR CREATING VASCULAR ACCESS ON UPPER EXTREMITIES WERE UNSUCCESSFUL. LASTLY A LEFT SIDED GREATER SAPHENOUS VEIN-FEMORAL ARTERY LOOP END TO SIDE ARTERIOVENOUS FISTULA HAS BEEN DONE FOR HIM.10 MONTHS LATER A RENAL TRANSPLANTATION FROM CADAVERIC DONOR HAS BEEN PERFORMED TO HIS LEFT ILIAC FOSSA. VASCULAR ANASTOMOSIS WERE; RENAL ARTERY TO INTERNAL ILIAC ARTERY END TO END, AND RENAL VEIN TO EXTERNAL ILIAC VEIN END TO SIDE. POSTOPERATIVELY HE WAS NORMAL EXCEPT OLIGURIA AND PERSISTANT HIGH SERUM CREATININ. DTPA SYNTIGRAPHY SHOWED ACCEPTABLE PERFUSION WITH NO EXCREATION. DOPPLER ULTRASONOGRAPHY (DOPPUSG) REVEALED PATENT RENAL VESSELS WITH INTERLOBAR RESISTIVE INDEX OF 0.66 (WITHIN NORMAL RANGES). COMPRESSION ON AVF DISTAL TO ALLOGRAFT PROMOTED RENAL BLOOD FLOW RATE WHICH IS DOCUMENTED BY DOPPUSG SO THAT BLOOD FLOW RATE WAS 58.9 CM/S WITHOUT COMPRESSION AND 79.9 CM/S WITH COMPRESSION WITHIN RENAL VEIN. CLINICALLY THIS COUSED A URINE OUTPUT OF 250 ML/H. AN URGENT SURGICAL OCCLUSION OF AVF HAS BEEN PERFORMED.
DISCUSSION & CONCLUSION: THIS CASE IS A DUAL ACTION OF STEAL SYNDROME THROUGH LOW PRESSURE AVF TO VENOUS SYSTEM DISTAL TO ALLOGRAFT, AND CREATION OF A HIGH PRESSURE WITHIN VENOUS SYSTEM OF ALLOGRAFT KIDNEY VIA IPSILATERAL EXTERNAL ILIAC VEIN WHICH ACT TOGETHER TO DECREASE RENAL BLOOD FLOW AND IN TURN GFR IN ALLOGRAFT KIDNEY. PROMT CORRECTION OF ALLOGRAT BLOOD FLOW AND PERFUSION CAN SAVE ALLOGRAFT KIDNEY'S FUCTION. ASSESSMENT OF PLACEMENT SITE FOR RENAL TRANSPLANTATION IS A PRIORITY WHICH SHOULD CONSERN BEFOR PROCEDURE.

 
Keyword(s): RENAL TRANSPLANTATION, ALLOGRAFT KIDNEY'S FUCTION, STEAL SYNDROME, RENAL VEIN BACK FLOW
 
 
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