J Korean Soc Transplant.  2012 Dec;26(4):287-292. 10.4285/jkstn.2012.26.4.287.

Acute Renal Failure in a Renal Allograft Recipient Caused by a Post-Biopsy Renal Arteriovenous Fistula with Transplant Renal Artery Stenosis

• Lee JH
• Lee HR
• Choi SH
• Jung P
• Oh JS
• Kim SM
• Sin YH
• Jung YS
• Jung GS
• Kim JK

• KMID: 2202432
• DOI: http://doi.org/10.4285/jkstn.2012.26.4.287

Abstract

Renal biopsy is an essential diagnostic tool for detecting acute and chronic kidney rejection as well as recurrent and de novo nephropathies in renal allograft recipients. However, a well-known complication of percutaneous renal biopsy is arteriovenous fistula (AVF). Most post-biopsy AVFs are asymptomatic and regress spontaneously but some AVFs result in hypertension, hematuria, and renal insufficiency. Whether post-biopsy AVF superimposed on transplant renal artery stenosis (TRAS) also regresses spontaneously is unknown. We present a case of acute renal insufficiency in a 51-year-old female renal allograft recipient with post-biopsy AVF and TRAS. Percutaneous angioplasty with stent implantation was performed for the TRAS and transcatheter arterial coil embolization therapy applied for AVF. The patient's renal function returned to baseline levels and is currently being followed up for 6 months.

Keyword

Renal biopsy of the transplanted kidney; Arteriovenous fistula; Transplant renal artery stenosis; Acute renal failure

MeSH Terms

Acute Kidney Injury
Angioplasty
Arteriovenous Fistula
Biopsy
Female
Hematuria
Humans
Hypertension
Kidney
Rejection (Psychology)
Renal Artery
Renal Artery Obstruction
Renal Insufficiency
Stents
Transplantation, Homologous
Transplants

Figure

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  Fig. 1 Clinical course: percutaneous balloon angioplaty with stent implantation for the transplant renal artery stenosis, transcatheter arterial coil emolization therapy for arteriovenous fistula (AVF). Abbreviations: Bx., biopsy; SCr, serum creatinine.

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  Fig. 2 Doppler ultrasound shows turbulent flow in a cystic mass, 2.1×1.2 cm sized (arterivenous fistula at lower pole of graft kidney).

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  Fig. 3 Renal angio 3-dimensional computed tomography findings shows severe stenosis at anastomosis site of transplanted renal artery and right internal ilicac artery (black arrow) and renal arteriovenous fistula in the lower pole of graft kidney (white arrow).

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  Fig. 4 Renal angiogram findings shows selective coiling of the feeding artery of the arteriovenous fistula with a platinum coil (white arrow) and stenosis at anastomosis site of transplanted renal artery and right internal ilicac artery (black arrow).

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  Fig. 5 Renal angiogram findings shows stent insertion at the transplant renal artery stenosis site with a normal blood flow (black arrow) and embolization of the feeding artery of the arteriovenous fistula with a platinum coil and gelfoam (white arrow).

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