July 30, 2010

Acute Tubular Necrosis

Tc-99m MAG3 renal scan of a renal transplant recipient, day 1 after transplant with oliguria, shows delayed excretion of tracer from the transplant kidney. Images in vascular phase (not shown) are normal (normal perfusion and uptake).

  • May occur immediately or after an initial short period of allograft function
  • Related to both donor and recipient factors
  • More common in cadaveric kidneys of older donors who sustained warm ischemia time or prolonged hypotensive periods
  • Presented with oliguria or anuria early after transplant
  • Diagnosis made by exclusion of other factors. Traditional signs (tubular casts, low urine osmolality) not reliable if patients with native partially functioning kidneys
  • Treatment: supportive, return to dialysis if anuric (expected recovery of renal function usually within 3 weeks)
Renal Scan
  • Normal perfusion, variable uptake but no (or delayed) excretion
  • Serial scans helpful in determining viability of oliguric kidneys, predicting recovery or deterioration

Resnick MI, Older RA. Diagnosis of Genitourinary Disease, 2nd edition, 1997

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