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Title: Emphysema in the renal allograft

Abstract

Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.

Authors:
; ; ;
Publication Date:
Research Org.:
Univ. of Texas Health Science Center, San Antonio
OSTI Identifier:
5611042
Report Number(s):
CONF-851152-
Journal ID: CODEN: RADLA; TRN: 85-016802
Resource Type:
Conference
Resource Relation:
Journal Name: Radiology; (United States); Journal Volume: 155:1; Conference: 71. scientific assembly and annual meeting, Chicago, IL, USA, 17 Nov 1985
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; EMPHYSEMA; DIAGNOSIS; IMMUNOSUPPRESSION; SIDE EFFECTS; KIDNEYS; BIOMEDICAL RADIOGRAPHY; COMPUTERIZED TOMOGRAPHY; GRAFTS; ULTRASONOGRAPHY; NEPHRITIS; DIABETES MELLITUS; PATIENTS; BODY; DIAGNOSTIC TECHNIQUES; DISEASES; ENDOCRINE DISEASES; MEDICINE; METABOLIC DISEASES; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; RESPIRATORY SYSTEM DISEASES; TOMOGRAPHY; TRANSPLANTS; UROGENITAL SYSTEM DISEASES; 550602* - Medicine- External Radiation in Diagnostics- (1980-)

Citation Formats

Potter, J.L., Sullivan, B.M., Fluornoy, J.G., and Gerza, C. Emphysema in the renal allograft. United States: N. p., 1985. Web.
Potter, J.L., Sullivan, B.M., Fluornoy, J.G., & Gerza, C. Emphysema in the renal allograft. United States.
Potter, J.L., Sullivan, B.M., Fluornoy, J.G., and Gerza, C. 1985. "Emphysema in the renal allograft". United States. doi:.
@article{osti_5611042,
title = {Emphysema in the renal allograft},
author = {Potter, J.L. and Sullivan, B.M. and Fluornoy, J.G. and Gerza, C.},
abstractNote = {Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.},
doi = {},
journal = {Radiology; (United States)},
number = ,
volume = 155:1,
place = {United States},
year = 1985,
month = 4
}

Conference:
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  • Data are presented on the clinical application of radionuclide imaging to evaluate changes in cadaver transplant function in the immediate postoperative period. The method uses orthoiodohippuric acid (hippuran) administered IV, with scintillation imaging, and curve analysis by a digital computer. An initial study is always obtained 24 hours after transplantation. Serial studies are then obtained, as needed, to interpret the clinical course. Selected cases are presented which illustrate the use of this protocol in various clinical settings. In the oliguric patient serial studies have been of particular value. They have identified ATN so that overenthusiastic treatment for rejection could bemore » avoided. They have also identified acute rejection complicating ATN so that high dose steroid therapy could be administered appropriately. In the nonoliguric patient they have frequently contributed to the early diagnosis of acute rejection, and they have been useful in monitoring the effect and duration of treatment for severe rejection crisis. It is concluded that radionuclide imaging studies, when carefully applied and interpreted, are a valuable adjunct to the management of patients in this complex clinical setting. (auth)« less
  • In order to determine if In-111m labeled platelet scanning could be of use in predicting renal allograft prognosis, 41 patients (pts) thought to be at risk for graft loss were studied. In vitro labeling of platelets was performed followed by reinjection into the pt and scanning at 24 hours. The graft activity on platelet scan was compared to hepatic activity and classified as being either less than or equal to hepatic activity (NEG) or much greater than hepatic activity (POS). Results are compared to graft prognosis and are presented in this paper. The observed increase in early loss rate inmore » the pts with POS scan over those with NEG scan was highly significant. (p .001). All pts with a POS scan were on cyclosporin A (CYA); no pt on conventional therapy (excluding CYA) had a POS scan. The authors conclude that the presence of a POS scan is a grave prognostic sign and that there appears to be a relationship between CYA, POS scan, and early graft loss.« less
  • The purpose of this study was to evaluate the diagnostic efficacy of temporal quantitation of SC compared to tissue diagnosis of AG needle biopsy (Bx). The principal clinical criteria for patient selection were sequential or persistent reduction (at least 40-50%) of AG function as determined by serial serum creatinine levels. Thirty-four AG recipients were examined with SC and subsequent AG Bx in 37 instances. %SC AG accumulation and bone marrow extraction were interpreted in view of the significant sequential of persistent reduction of Ag function. Each AG Bx was collected from multiple needle aspirates and processed for light microscopy andmore » immunoflorescent staining. Bx and SC exam were evaluated for acute rejection (AR), chronic rejection (CR) or other, non-rejection pathology. Acute tissue changes superimposed on chronic were regarded as AR. Acute tissue changes and % SC AG accumulation in the rejection range were graded as mild, moderate and marked. In AR there was 28/28 agreement of Bx and SC diagnosis; of which 7/28 were superimposed on CR. In Cr Bx and SC agreed in 3/7 instances, in 3/7 SC Dx was AR and in 1/7 SC exam was normal. Sensitivity and specificity of the SC diagnosis in this series was 100% and 63% for AR, 43% and 100% for CR and 97% and 100% in all instances of rejection. Bx and SC grading of AR agreed in 64%. In conclusion, temporal quantitation of SC demonstrated overall good correlation with AG Bx diagnosis in this series. The poor sensitivity of 43% of SC in Cr and only 64% correlation in grading AR may be due to inherent Bx sampling and SC data analysis error.« less
  • Followup renal scintiscans using two radiopharmaceuticals were performed in a patient with renal emphysema. This allowed us to more accurately determine whether the emphysematous pyelonephritis was responding to antibiotic therapy or whether surgical intervention was indicated. Both Ga-67 citrate and a cortical agent (Tc-99m dimethylsuccinate) were used. A reciprocal relationship in the renal uptake of these two agents indicates the response of therapy and the degree of improvement of renal cortical function.
  • A prospective, single-blinded study was done to determine the ability of serial 99mtechnetium-diethylenetriaminepentaacetic acid scans to diagnose renal allograft rejection. Among 28 transplant recipients 111 renal scans were obtained 1 day postoperatively and every 3 to 4 days thereafter for 3 weeks in all patients retaining an allograft. Computer-generated time-activity blood flow curves were analyzed semiquantitatively for the 1) interval between curve peaks of the allograft and iliac artery, 2) renal transit time and 3) renal washout of radionuclide. Excretory function was assessed by degree and interval to appearance of radionuclide in the calices and bladder. Deterioration of renal bloodmore » flow and excretion compared to the initial scan was considered rejection. Of 52 scans performed during clinical rejection 47 (90.4 per cent) were interpreted as showing rejection (sensitivity). Of 53 scans interpreted as showing rejection 47 (88.7 per cent) were positive for clinical rejection. The remaining 6 patients (initial false positive results) suffered clinical rejection within 24 to 72 hours. We conclude that 99mtechnetium-diethylenetriaminepentaacetic acid renal scans are useful in the differential diagnosis of renal allograft dysfunction.« less