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Kidney Week

Abstract: PO2565

Trouble Brui-ing: A Case of Doppler Discovery

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Fairless, Brandon M., Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
  • Paramesh, Anil S., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Ashoor, Isa, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
Introduction

This case highlights the clinical presentation and management of an uncommon kidney transplant biopsy complication.

Case Description

A 19 year old male with ESKD, now status-post second deceased donor kidney transplant, presented to clinic with hypertension. Post transplant course included 3 prior normal surveillance kidney transplant biopsies. Graft function was stable (creatinine 1 mg/dL), and tacrolimus trough level was therapeutic. His blood pressure was 130/85. Exam showed a palpable thrill with audible bruit over the graft site. Ultrasound showed a sonolucent lesion in the lower pole of the transplant kidney, which was not present on prior imaging. Doppler revealed turbulent flow concerning for an arteriovenous malformation (AVM). Renal angiography confirmed the diagnosis, and he underwent endovascular embolization with coiling [Image]. Graft function and blood pressure readings remain normal on most recent follow-up

Discussion

Kidney biopsy is commonly utilized for diagnosis and management of transplant complications. It is generally a safe procedure, with post-biopsy bleeding being the most common complication, often with no clinical significance. However, serious complications can occur, with AVM among them. Patients with kidney transplants have been noted to have a higher incidence of post-biopsy AVM. A portion of AVMs remain asymptomatic and self-resolve, while others manifest as hypertension, graft dysfunction, and hematuria. An ultrasound with Doppler is critical for the diagnosis. Endovascular embolization is an effective and minimally invasive management option for most patients.

Teaching Points
-Ultrasound with Doppler assesses for the presence of AVM
-Symptoms of post-biopsy AVM include hypertension, renal graft dysfunction, and gross hematuria
-Transplant patients are at increased risk for post-biopsy AVM

Renal ultrasound with Doppler (left), renal angiography (middle), post-coiling (right)