Abstract: SA-PO040
MR Urogram Without Contrast in Transplant Obstructive Uropathy
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Infante, Juan Carlos, University of Miami, Miami, Florida, United States
- Chandar, Jayanthi, University of Miami/Jackson Health Systems, Miami, Florida, United States
- Ciancio, Gaetano, University of Miami, Miami, Florida, United States
- Defreitas, Marissa J., University of Miami/Jackson Health Systems, Miami, Florida, United States
- Alam, Alireza, Jackson Memorial Hospital, Miami, Florida, United States
- Katsoufis, Chryso P., University of Miami/Jackson Health Systems, Miami, Florida, United States
- Ali, Mohammed Farhan, University of Miami/Jackson Health Systems, Miami, Florida, United States
- Abitbol, Carolyn L., University of Miami/Jackson Health Systems, Miami, Florida, United States
Introduction
After kidney transplantation, hydronephrosis is a common problem that may result from obstruction or reflux. A voiding cystourethrogram entails urethral catheterization, radiation exposure, and patient discomfort. Alternatively, an MR urogram (MRU) can be performed without any potentially toxic intravenous (IV) contrast agent. We present a case that shows the feasibility MRU with an IV saline bolus and furosemide only.
Case Description
A 17 year-old boy with a kidney transplant presented with rising creatinine and recurrent hydronephrosis 9 months after the transplant. The immediate post-transplant course was notable for hydronephrosis and stricture in the ureterovesical junction (UVJ) treated with balloon ureteroplasty one month after surgery. The hydronephrosis improved after balloon ureteroplasty, but over the next 5 months there was a gradual decline in kidney function and the patient experienced recurrent episodes of acute kidney injury (AKI). Renal ultrasound showed recurrence of the hydronephrosis; the differential included recurrence of the UVJ stricture versus reflux. An MRU without contrast revealed “moderate hydroureteronephrosis with tight narrowing at the UVJ.” Intraoperatively, stone fragments were discovered along the wall of the distal ureter causing obstruction of the UVJ, but no stricture was present. The ureteral re-implantation was revised to allow passage of possible future stones. There were no further episodes of AKI or hydronephrosis up to 4 months after the revision.
Discussion
MRU using IV saline and furosemide can yield high-quality 3D images that identify targets for intervention in the setting of renal dysfunction while also avoiding nephrogenic systemic fibrosis.
3D MR urogram without contrast showing (A) moderate hydroureteronephrosis and tight narrowing near the UVJ. (B) Hollow view shows the narrowing near the UVJ followed by the urine jets in the bladder, consistent with partial obstruction.