Abstract: TH-PO568
AKI from Orthostatic Renal Graft Compression Following Weight Gain
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Hultin, Sebastian Olof, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Fisher, Charles, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Thebridge, Linda, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Pollock, Carol A., The University of Sydney, St. Leonards, New South Wales, Australia
Introduction
We present the first reported case of orthostatic renal graft compression from central adiposity resulting in acute kidney injury.
Case Description
A 61 year old man with a cadaveric transplant presented with hypertension and acute kidney injury with a creatinine rise from 80 to 210 µmol/L. His past medical history included controlled diabetes, hypertension, ischaemic heart disease, and obesity requiring gastric sleeve with subsequent weight gain from 90 to 110kg. Renal biopsy was consistent with acute tubular necrosis without significant interstitial inflammation or signs of rejection.
Serial renovascular duplex studies of the transplant graft were abnormal. Initial scanning showed severely reduced diastolic flow normalising towards the upper pole (RI0.78). The renal vein flow had normal phasicity and renal artery velocity was 336cm/s. Repeat scanning showed absence of diastolic flow and reduced perfusion despite a patent renal transplant artery and vein. Raising the fatty apron cephalad normalised renal blood flow with resistive indices between 0.76-0.79 throughout the kidney. Subsequent laparascopy ruled out adhesional obstruction and CO2 angiogram confirmed normal transplant vessels, anastomotic sites and intra-renal branches.
Following initial empiric pre-biopsy pulsed steroids for presumed rejection, he was treated with bedrest and his creatinine was130µmol/L on discharge. Whilst advising weight loss, he was treated with an abdominal support belt.
Discussion
Our case highlights the potential growing problems of increasing obesity and inadequate assessment tools to assess abdominal weight gain in transplant patients. Transplant physicians and surgeons need to be aware of renal graft compression from an enlarged bulky omentum and fatty apron. Diagnosis requires positional prone doppler sonography. Aside from weight loss, optimal treatment is not known.