Incidence:
0.5%-4% and frequently results in graft loss
Risk
factors:
Technique error
Hypovolaemia
Atherosclerosis
OKT3 (plus high-dose methylprednisolone)
Antiphospholipid antibodies
High dose steroids
Long cold ischaemia time
Delayed graft function recovery
Certain renal diseases( membranous GN, SLE)
Antiphospholipid antibody syndrome
Use of oral contraception,
Hereditary thrombophilia secondary to protein C or factor V deficiency
Clinical presentation:
Acute anuria, hematuria,
graft tenderness, primary non function of the graft
Best test:
Renal sonogram with dopplers
waveform evaluation( most important part)
A normal renal arterial waveform in either an allograft or native kidney shows antegrade flow throughout the entire cardiac cycle. Reversal of diastolic flow in the allograft renal artery, although not specific, is considered abnormal. This finding is caused by a significant increase in resistance in small intrarenal or large extrarenal vessels. This sign is not pathognomonic for renal vein thrombosis ( as can be seen with ATN or rejection as well). Renal vein thrombosis was more likely to occur in the acute (24 hours) and perioperative (30 days) periods. It is important to recognize the abnormal duplex Doppler waveform pattern, reversal of diastolic flow, which is associated with renal vein thrombosis.
A normal renal arterial waveform in either an allograft or native kidney shows antegrade flow throughout the entire cardiac cycle. Reversal of diastolic flow in the allograft renal artery, although not specific, is considered abnormal. This finding is caused by a significant increase in resistance in small intrarenal or large extrarenal vessels. This sign is not pathognomonic for renal vein thrombosis ( as can be seen with ATN or rejection as well). Renal vein thrombosis was more likely to occur in the acute (24 hours) and perioperative (30 days) periods. It is important to recognize the abnormal duplex Doppler waveform pattern, reversal of diastolic flow, which is associated with renal vein thrombosis.
Treatment:
Timely returning back to the OR for thrombectomy and or reconstruction of venous component
Streptokinase or urokinase
Percutaneous mechanical thrombectomy and
Localized catheter-directed thrombolysis
Timely returning back to the OR for thrombectomy and or reconstruction of venous component
Streptokinase or urokinase
Percutaneous mechanical thrombectomy and
Localized catheter-directed thrombolysis
But
overall, prognosis is poor with many times leading to nephrectomy.
Two great reviews:
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