Impaired response to intrarenal administered atrial natriuretic peptide in ischemic acute renal failure of a transplanted patient.

A 30-year-old male patient suffering from membrano-proliferative glomerulonephritis was transplanted a cadaveric kidney 3 years ago. Five days later the transplant was removed because of fresh thrombosis in larger arteries. Three years after first transplantation a second graft was transplanted. Repeated perfusion scintigraphies of persistent anuric patient showed a delayed perfusion of renal parenchyma, no intrarenal bolus was obtained. Urgently, an arterial angiography was performed. It demonstrated that calibers of renal parenchymal vasculature were narrowed. Suggesting ischemic nature of acute renal failure, 50 micrograms human atrial natriuretic peptide (hANP) was injected intrarenally as bolus. Five minutes after hANP injection in a second angiography a significant improvement of renal blood flow was demonstrated but no amelioration of urine production or electrolyte excretion was observed. Histologically an ischemic lesion of transplant was proven. This finding indicates a blunted excretory response of acute renal failure after kidney transplantation despite of significantly ameliorated renal blood flow visualized radiologically.