Zur Differentialdiagnose der Abstoßungsreaktion transplantierter Nieren mit Hilfe nuklearmedizinischer Verfahren

Is serial iodohippurate renography at the bedside reliable enough to monitor renal transplants?

Renograms were obtained immediately after transplantation and repeated every other day beginning 4 days after renal transplantation. In 31 of 32 biopsy-proved acute rejection crises a flattening of phase II (secretion phase) of the renogram occurred. Of the 32 renogram changes 7 were the only signs of rejection at the time of renography. This finding confirms our previous impression based on 116 rejection episodes (diagnosed according to clinical symptoms and response to therapy) that phase II alteration in serial renograms is a sensitive and probably specific sign of rejection. Because this simple method to monitor renal transplantation is not invasive, can be done at the bedside, and gives immediate and easily interpreted results repeated renography is recommended as the basic screening method. Renography is helpful especially in patients with acute tubular necrosis after renal transplantation. The need for more invasive diagnostic procedures, such as renal biopsy and angiography, can be shown by such renograms, although this has occurred rarely in our experience.

Urography and isotope renography following renal transplantation

The clinical yield from routine urography following renal transplantation was compared with that from isotope renography. In 50 recipients of renal transplants, 59 urograms and 55 renograms were studied. The most common pathologic finding at urography was renal papillary necrosis (in 6 patients). This condition had no obvious correlation with the further fate of the transplant. There were no other significant pathologic changes. It is concluded that isotope renography can be regarded as sufficient for routine follow-up. One baseline urogram is useful, but additional urographies should be carried out only when clinically indicated.