Severely elevated intrarenal arterial impedance and abnormal venous flow pattern in a normal functioning kidney graft.

Serial Doppler sonographic impedance measurements represent the most common diagnostic method for noninvasive monitoring of kidney grafts. Severely elevated arterial impedance is almost always associated with graft dysfunction. However, we describe in the present work a renal transplant recipient with optimal graft function despite permanently elevated arterial impedance (pulsatility index (PI) ranging from 2.9-3.0, and resistive index (RI) = 1.0 as well as an abnormal venous flow pattern. In contrast, the contralateral graft from the same cadaver donors transplanted into a 17-year-old female patient displayed normal range PI and RI values in conjunction with a normal serum creatinine. Known causes of arterial impedance elevation such as rejection, cyclosporine, urinary obstruction, and external graft compression were excluded. Other extrarenal causes of high impedance, such as aortic insufficiency and reduced aortic compliance, were also excluded. No evidence of impaired venous outflow at the site of the anastomosis of the main renal vein to the iliac vein was found. Those findings support the view that impedance indexes are hemodynamic rather than functional parameters.

Ligation of the left renal vein in epm1-Wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands.

OBJECTIVE: The ligation of the left renal vein (LLVR) in man is a controversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. MATERIAL AND METHODS: 64 male adult EPM1-WISTAR rats were used, divided into 8 groups-4 for LLRV and four for control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. RESULTS: We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice. The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance. CONCLUSION: Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.