Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
Nephrology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
Transplant Proc. 2024 Jun;56(5):1055-1058. doi: 10.1016/j.transproceed.2024.01.008. Epub 2024 Feb 13.
Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplantation, with an incidence ranging from 1% to 23%. TRAS often presents with clinical features such as refractory hypertension, de novo hypertension, allograft dysfunction, and the presence of a bruit over the graft. A rare manifestation of TRAS is flash pulmonary edema. Here, we present a case of a 37-year-old male who received a living donor kidney. Four years after the transplant, he presented with acute kidney injury, hypertensive crisis, and flash pulmonary edema. Initially, methylprednisolone pulses were administered due to suspicion of acute rejection, which was later ruled out after a kidney graft biopsy. Computed tomography angiography showed findings suggesting stenosis or thrombus in the renal artery. The patient developed sudden acute pulmonary edema, requiring hemodialysis, with notable clinical improvement. Subsequently, stent placement was performed without complications, resulting in the complete recovery of renal function and effective blood pressure control. The incidence of renal artery stenosis is higher in living donor kidney transplantation, mainly due to technical complexities during surgery. Acute presentations, such as flash edema, are exceptionally rare but can occur years after transplantation. Prompt intervention can lead to favorable outcomes.
移植肾动脉狭窄（TRAS）是肾移植后一种公认的血管并发症，其发生率为 1%至 23%。TRAS 常表现为难治性高血压、新发高血压、移植物功能障碍以及移植肾区杂音等临床特征。TRAS 的一种罕见表现为闪发性肺水肿。在此，我们报告 1 例 37 岁男性患者，他接受了活体供肾移植。移植后 4 年，他出现急性肾损伤、高血压危象和闪发性肺水肿。最初，由于怀疑急性排斥反应，给予甲基强的松龙冲击治疗，但在进行肾移植活检后排除了该诊断。计算机断层血管造影显示肾动脉狭窄或血栓形成的表现。患者突发急性肺水肿，需要血液透析，临床症状显著改善。随后，成功进行了支架置入术，无并发症发生，肾功能完全恢复，血压得到有效控制。活体供肾移植后肾动脉狭窄的发生率较高，主要与手术过程中的技术复杂性有关。急性表现，如闪发性水肿，非常罕见，但可在移植后数年发生。及时干预可获得良好的结果。
