Granata Antonio, Clementi Silvia, Clementi Anna, Di Pietro Fabio, Scarfia Viviana R, Insalaco Monica, Aucella Filippo, Prencipe Michele, Fiorini Fulvio, Sicurezza Elvia
U.O.C. Nefrologia e Dialisi, Ospedale San Giovanni di Dio, Agrigento, Italy.
G Ital Nefrol. 2012 Nov-Dec;29 Suppl 57:S90-8.
Kidney transplantation is the treatment of choice for end-stage renal disease, given the better quality of life of transplanted patients when compared to patients on maintenance dialysis. In spite of surgical improvements and new immunosuppressive regimens, part of the transplanted grafts still develop chronic dysfunction. Ultrasonography, both in B-mode and with Doppler ultrasound, is an important diagnostic tool in case of clinical conditions which might impair kidney function. Even though ultrasonography is considered fundamental in the diagnosis of vascular and surgical complications of the transplanted kidney, its role is not fully understood in case of parenchymal complications of the graft. The specificity of Doppler ultrasound is low both in case of acute complications such as acute tubular necrosis, drug toxicity and acute rejection, and in case of chronic conditions such as chronic allograft nephropathy. Single determinations of resistance indices present low diagnostic accuracy, which is higher in case of successive measurements performed during the follow-up of the graft. Modern techniques including tissue pulsatility index, maximal fractional area and contrast-enhanced ultrasound increase the diagnostic power of ultrasonography in case of parenchymal complications of the transplanted kidney.
肾移植是终末期肾病的首选治疗方法，因为与接受维持性透析的患者相比，肾移植患者的生活质量更高。尽管手术技术有所改进，免疫抑制方案也不断更新，但仍有部分移植肾发生慢性功能障碍。B 超和多普勒超声检查是诊断可能损害肾功能的临床情况的重要工具。尽管超声检查被认为是诊断移植肾血管和手术并发症的基础，但在移植肾实质并发症方面，其作用尚未完全明确。多普勒超声在急性并发症（如急性肾小管坏死、药物毒性和急性排斥反应）以及慢性疾病（如慢性移植肾肾病）中的特异性都很低。单次测量阻力指数的诊断准确性较低，而在移植肾随访期间进行连续测量时，诊断准确性会更高。包括组织搏动指数、最大分数面积和超声造影在内的现代技术提高了超声检查在诊断移植肾实质并发症方面的诊断能力。
