The Application Of Ultrasonography In The Diagnosis Of The Renal Allograft Medical Complications

Objective:To investigate the clinical value of ultrasonography assists to diagnose the renal allograft medical complications.Methods:Ninety-six patients were examined with totally 258 times successional ultrasound scan after transplantation.Renal allograft tissues were obtained by ultrasound-guided biopsy,in 31 cases with medical complications. According to the clinical symptoms and pathology specimen,some corresponds to absence of complications were defined as normal transplanted kidney(NTK),others with medical complications were divided into there groups:acute rejection(AR) group,acute tubular necrosis(ATN)group and chronic complications group(chronic rejection,CR and chronic allograft nephropathy,CAN).The retrospective analyzed were performed.Results:(1)In renal allografts groups with medical complication,we found that various abnormal appearances can be displayed on 2DUS.As well as allograft perfusion areas were less than normal transplant kidney group on CDFI.And then, abnormal waveform of frequency spectrum can be detected.(2)In the group of AR,the width of grafts was wider than other groups(P＜0.05);in the groups of AR and ATN,the thickness and velocity of grafts were increased as compared with NTK and chronic complications cases(P＜0.05);in total groups with medical complication,other findings included increased renal parenchyma thickness, cortical thickness,pyramid height and resistance index(RI)of various grades renal arteries than NTK(P＜0.05),among which the cases of ATN showed most significant changes(P＜0.05).(3)In our experience,we have found the need for a scoring system,the system given a four point score for ultrasonic appearance,0-1 being a NTK and 2-5 indicating appearance of renal transplant medical complications.With the scoring system,the sensitivity was 89.4%,the specificity was 88.0%,the positive predictive value was 90.0%,negative predictive value was 87.3%,the rate of accurate was 88.8%.(4)There were 7 factors perhaps affect the patients' prognosis,such as the score obtained by the 'ultrasonic appearance scoring system',RI of interlobar artery of renal allograft,age,sex,urine volume,SCr and BUN in period of first 3 month after the transplantation operation,the multiple factor regression analysis were used,the result,shown the score for ultrasonic appearance was risk factor for patients' prognosis after transplantation.(5)There were some characters on arise time on three kinds of medical complications:ATN occurs most in the 1st month postsurgery.AR can arise in any period while usually take play in the 1st year after the operation.CR and CAN usually occurre in the period of the 1st year after transplant.Conclusions:Ultrasonograph is an unequivocally the most valuable noninvasive imaging modality used in monitering the renal transplant.For the medical complications after renal allograft operation,the scoring system given a four point score for ultrasonic appearance could improve the sensitivity,specificity and accuracy of diagnosis.Combination the scoring system for ultrasonic appearance and the characters on arise time of AR,ATN,CR and CAN may improve the differential diagnosis on various kinds medical complications.