Beaubien-Souligny William, Pépin Marie-Noëlle, Legault Louis, Cailhier Jean-François, Éthier Jean, Bouchard Louis, Willems Bernard, Denault André Y
Division of Nephrology, Centre Hospitalier de l'Université de Montréal, QC, Canada.
Department of Anesthesiology and Intensive care, Centre Hospitalier de l'Université de Montréal, QC, Canada.
Can J Kidney Health Dis. 2018 Oct 3;5:2054358118801012. doi: 10.1177/2054358118801012. eCollection 2018.
Acute kidney injury (AKI) is a frequent complication after liver transplantation. In some patients, prompt intervention targeted at a specific etiology is of paramount importance.
A 25 years old man with advanced liver cirrhosis caused by sclerosing cholangitis and autoimmune hepatitis underwent orthotopic liver transplantation. One month after surgery, severe AKI developed in conjunction with recurrent ascites and lower extremity edema. Notable clinical findings included a persistently low urinary sodium excretion, a bland urinary sediment, and an abnormally monophasic hepatic vein waveform on Doppler ultrasound.
Inferior vena cava stenosis.
Angioplasty with stent installation.
Rapid improvement of renal function after stent installation.
The following case illustrates the importance of integrating clinical cues, ultrasound features, and laboratory findings. The combination of AKI associated with lower extremity edema, abnormal monophasic hepatic vein flow on Doppler ultrasound, and a low urinary sodium excretion after liver transplantation should evoke the possibility of inferior vena cava stenosis as the etiologic factor.
急性肾损伤（AKI）是肝移植术后常见的并发症。对于一些患者，针对特定病因的及时干预至关重要。
一名25岁男性，因硬化性胆管炎和自身免疫性肝炎导致晚期肝硬化，接受了原位肝移植。术后1个月，出现严重AKI，同时伴有反复腹水和下肢水肿。显著的临床发现包括尿钠排泄持续降低、尿沉渣正常以及多普勒超声显示肝静脉波形异常单相。
下腔静脉狭窄。
血管成形术并安装支架。
安装支架后肾功能迅速改善。
以下病例说明了整合临床线索、超声特征和实验室检查结果的重要性。肝移植后，AKI合并下肢水肿、多普勒超声显示肝静脉血流异常单相以及尿钠排泄降低，应考虑下腔静脉狭窄作为病因的可能性。
