Department of Surgery, Transplant Unit, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, India.
Saudi J Kidney Dis Transpl. 2021 Jul-Aug;32(4):1134-1140. doi: 10.4103/1319-2442.338287.
Oliguria in the early postoperative phase after renal transplantation has many causes with overlapping presentations. Page kidney refers to external compression of the kidney by a hematoma, urinoma or tumor, leading to parenchymal hypoperfusion, unexplained hypertension (HTN), or frank acute renal failure. About 100 cases of Page kidney are reported; mostly after kidney biopsy. After the analysis of records, we identified four cases of acute Page kidney posttransplant, akin to a compartment syndrome. All biochemical, laboratory, and clinical parameters were recorded. Cases occurred within two to three weeks of transplant, with different causes. Clinical presentation was sudden, with HTN, raised serum creatinine and perigraft swelling in all. Rejection co-existed Page kidney in two cases, while tacrolimus had to be potentiated with diltiazem in one case. Serial parameters such as increased resistive index (>0.7), perigraft collection, and absent diastolic flow with normal peak systolic velocity were consistent with diagnosis. Two were caused by lymphoceles, more than 3 L. Both were managed by laparoscopic fenestration surgery; probably the first such instance for Page kidney. Two patients had postoperative hematoma; in one case, it followed early percutaneous angiographic stenting and "leakage" from the transplant artery, only the second such report. A high index of suspicion required for diagnosis; after excluding rejection and pre/postrenal causes, aggressive early management is the key for graft salvage.
肾移植后早期少尿有许多原因，其临床表现有重叠。假性动脉瘤肾是指血肿、尿囊肿或肿瘤对外科肾脏的外部压迫，导致实质灌注不足、不明原因的高血压（HTN）或急性肾衰竭。大约有 100 例假性动脉瘤肾的报告；主要发生在肾活检后。在分析记录后，我们确定了 4 例移植后急性假性动脉瘤肾，类似于间隔综合征。所有生化、实验室和临床参数均有记录。这些病例发生在移植后两到三周，病因不同。临床表现为突然出现高血压、血清肌酐升高和移植肾周围肿胀。在两种情况下同时存在排斥反应，而在一种情况下，他克莫司必须与地尔硫卓联合使用以增强作用。连续参数如阻力指数升高（>0.7）、移植肾周围积液和无舒张期血流而收缩期峰值流速正常，与诊断一致。其中 2 例是由超过 3 升的淋巴囊肿引起的。两者均通过腹腔镜开窗手术进行治疗；可能是首例假性动脉瘤肾的此类病例。有 2 例患者术后发生血肿；在 1 例中，它发生在早期经皮血管内支架置入术和移植动脉的“渗漏”之后，这是第二个此类报告。需要高度怀疑以进行诊断；在排除排斥和肾前/肾后原因后，积极的早期治疗是挽救移植物的关键。
