Clinical note
Renogram in kidney transplant. Utility of delayed images with SPECT/CT in the diagnosis of urinary leak
Renograma en trasplante renal. Utilidad de imágenes tardías con SPECT/TC para el diagnóstico de fuga urinaria
J. Gómez Hidalgo
, M.Á. Ruiz Gómez, C. Gamazo Laherrán, M. Alonso Rodríguez, A. Sainz Esteban, R. Ruano Pérez
Corresponding author
Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Read
49
Timeswas read the article
10
Total PDF
39
Total HTML
Share statistics
array:23 [ "pii" => "S2253808918301022" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.10.011" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1007" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:46-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 8 "formatos" => array:2 [ "HTML" => 4 "PDF" => 4 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X18301070" "issn" => "2253654X" "doi" => "10.1016/j.remn.2018.07.003" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1007" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:46-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 156 "formatos" => array:2 [ "HTML" => 85 "PDF" => 71 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nota clínica</span>" "titulo" => "Renograma en trasplante renal. Utilidad de imágenes tardías con SPECT/TC para el diagnóstico de fuga urinaria" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "49" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Renogram in kidney transplant. Utility of delayed images with SPECT/CT in the diagnosis of urinary leak" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figura 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1433 "Ancho" => 3167 "Tamanyo" => 378137 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Imágenes SPECT-TC con <span class="elsevierStyleSup">99m</span>TC-DTPA a las 2<span class="elsevierStyleHsp" style=""></span>horas de la administración del radiofármaco del caso 2. Se observan 3 pequeños depósitos de hipercaptación, correspondientes a actividad urinaria. Uno de ellos de localización superior y adyacente al parénquima y al tubo de drenaje, otro de localización inguinal e inferior a la vejiga y el otro por debajo de polo inferior del injerto (flecha blanca), compatibles con fuga urinaria.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Gómez Hidalgo, M.Á. Ruiz Gómez, C. Gamazo Laherrán, M. Alonso Rodríguez, A. Sainz Esteban, R. Ruano Pérez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Gómez Hidalgo" ] 1 => array:2 [ "nombre" => "M.Á." "apellidos" => "Ruiz Gómez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Gamazo Laherrán" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alonso Rodríguez" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Sainz Esteban" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Ruano Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808918301022" "doi" => "10.1016/j.remnie.2018.10.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918301022?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301070?idApp=UINPBA00004N" "url" => "/2253654X/0000003800000001/v1_201901110626/S2253654X18301070/v1_201901110626/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2253808918300788" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.08.002" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:50-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 6 "formatos" => array:2 [ "HTML" => 2 "PDF" => 4 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The role of <span class="elsevierStyleSup">18</span>F-FDG PET/CT imaging in the diagnosis of ovarian cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "50" "paginaFinal" => "51" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la PET/TC con <span class="elsevierStyleSup">18</span>F-FDG en el diagnóstico del cáncer de ovario" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Domenico Rubello, Maria Cristina Marzola, Patrick M. Colletti" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Domenico" "apellidos" => "Rubello" ] 1 => array:2 [ "nombre" => "Maria Cristina" "apellidos" => "Marzola" ] 2 => array:2 [ "nombre" => "Patrick M." "apellidos" => "Colletti" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18301859" "doi" => "10.1016/j.remn.2018.08.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301859?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918300788?idApp=UINPBA00004N" "url" => "/22538089/0000003800000001/v1_201901110618/S2253808918300788/v1_201901110618/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808918301198" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.11.007" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1025" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:38-45" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special collaboration</span>" "titulo" => "Development of a positron emission tomography risks map" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "38" "paginaFinal" => "45" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desarrollo de un mapa de riesgos para la tomografía por emisión de positrones" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2133 "Ancho" => 2250 "Tamanyo" => 220590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">PET process.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Rodríguez Fernández, E.M. Triviño Ibáñez, M. Gómez Río, J.J. Pérez Lázaro, I. Fernández Ruiz, Á. Ramírez Navarro, Y. García Rivero, E. Córdoba Cañete, C. Romero Fernández, J.M. Llamas-Elvira" "autores" => array:10 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez Fernández" ] 1 => array:2 [ "nombre" => "E.M." "apellidos" => "Triviño Ibáñez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gómez Río" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Pérez Lázaro" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Fernández Ruiz" ] 5 => array:2 [ "nombre" => "Á." "apellidos" => "Ramírez Navarro" ] 6 => array:2 [ "nombre" => "Y." "apellidos" => "García Rivero" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Córdoba Cañete" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Romero Fernández" ] 9 => array:2 [ "nombre" => "J.M." "apellidos" => "Llamas-Elvira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18301550" "doi" => "10.1016/j.remn.2018.09.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301550?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918301198?idApp=UINPBA00004N" "url" => "/22538089/0000003800000001/v1_201901110618/S2253808918301198/v1_201901110618/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "Renogram in kidney transplant. Utility of delayed images with SPECT/CT in the diagnosis of urinary leak" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "49" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Gómez Hidalgo, M.Á. Ruiz Gómez, C. Gamazo Laherrán, M. Alonso Rodríguez, A. Sainz Esteban, R. Ruano Pérez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Gómez Hidalgo" "email" => array:1 [ 0 => "jgomezh@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.Á." "apellidos" => "Ruiz Gómez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Gamazo Laherrán" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alonso Rodríguez" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Sainz Esteban" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Ruano Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Renograma en trasplante renal. Utilidad de imágenes tardías con SPECT/TC para el diagnóstico de fuga urinaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1122 "Ancho" => 2167 "Tamanyo" => 111158 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Early and delayed planar images focused on pelvis performed at 30 and 120<span class="elsevierStyleHsp" style=""></span>min, respectively. Radiotracer activity is observed adjacent to distal third of ureter (black arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Urinary leakage in patients with kidney transplantation is a relatively common surgical complication that requires early diagnosis and intervention. The isotopic renogram is a non-invasive and effective method to evaluate the perfusion and function of the kidney graft, and also permits to detect urological complications such as urinary leakage.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Delayed planar and SPECT/CT images are needed to reach the diagnosis and locate the leakage.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">51 year old female, without known drug allergies, under hemodialysis because of chronic renal disease, and diagnosed of arterial hypertension, hypertensive cardiomyopathy and secondary hyperparathyroidism. Hospitalized as a possible kidney transplant recipient. Blood analysis: urea 29<span class="elsevierStyleHsp" style=""></span>mg/dL, creatinine (Cr) (after hemodialysis) 1.62<span class="elsevierStyleHsp" style=""></span>mg/dL, glucose 110<span class="elsevierStyleHsp" style=""></span>mg/dL, total protein 7.7<span class="elsevierStyleHsp" style=""></span>mg/dL, Na 143<span class="elsevierStyleHsp" style=""></span>mEq/L, K 2.9<span class="elsevierStyleHsp" style=""></span>mEq/L. Donor: Female 57 years old, blood type O+ who died due to a hemorrhagic stroke. Cr 0.5<span class="elsevierStyleHsp" style=""></span>mg/dL, urea 37<span class="elsevierStyleHsp" style=""></span>mg/dL, urine test: without alterations. Renal ultrasound: 12<span class="elsevierStyleHsp" style=""></span>mm cortical cyst. Serology and cross-match: negatives.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The cadaver kidney was implanted in the patient's right iliac fossa with 3 arteries in one patch, 1 vein and 1 ureter. As an intraoperative complication, the recipient presented an acute anemia needing of two red blood cells transfusions; and also because of a thrombus in the renal vein a venotomy was required to extract the thrombus. Good vascularization was observed after kidney declamping. She also presented a delay in graft function requiring a hemodialysis session.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first <span class="elsevierStyleSup">99m</span>Tc-DTPA post-transplant renogram was performed at 24<span class="elsevierStyleHsp" style=""></span>h, showing only mild acute tubular necrosis. As renal function deteriorated in the following days, a second renogram was performed the 10th day with the following findings:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Vascular phase: kidney graft well perfused in the right iliac fossa.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Clearance phase: immediate and homogeneous uptake in the renal parenchyma. Activity in the renal pelvis was seen but not in the bladder during the first 30<span class="elsevierStyleHsp" style=""></span>min of the study (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Early and delayed static images and delayed SPECT/CT: an anomalous accumulation of radiotracer in the periureteral region, in relation to an urinary leakage (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">After the scintigraphic diagnosis, a translumbar percutaneous puncture of the renal graft was performed in order to insert a percutaneous nephrostomy tube and a double J ureteral catheter. Two days later, the nephrostomy catheter was closed and the patient was discharged from hospital (blood test: urea 36<span class="elsevierStyleHsp" style=""></span>mg/dL, Cr 1.1<span class="elsevierStyleHsp" style=""></span>mg/dL, glucose 85<span class="elsevierStyleHsp" style=""></span>mg/dL).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical case 2</span><p id="par0045" class="elsevierStylePara elsevierViewall">67 year old male on hemodialysis with a clinical history of chronic kidney failure secondary to diffuse glomerulosclerosis, also diagnosed of secondary hyperparathyroidism, hyperuricemia, chronic obstructive pulmonary disease and thrombophlebitis in the lower extremities. He was admitted at the hospital as a possible recipient of a cadaver kidney transplant. Blood test on admission: Urea 71<span class="elsevierStyleHsp" style=""></span>mg/dL. Cr 8.28<span class="elsevierStyleHsp" style=""></span>mg/dL, total protein 6.9<span class="elsevierStyleHsp" style=""></span>mg/dL, glucose 115<span class="elsevierStyleHsp" style=""></span>mg/dL, Na 140<span class="elsevierStyleHsp" style=""></span>mEq/L, K 4.5<span class="elsevierStyleHsp" style=""></span>mEq/L. Donor: A 68 year old male, blood type A+, died from a subarachnoid hemorrhage. Diuresis: 100<span class="elsevierStyleHsp" style=""></span>mL/h, Cr 1.09<span class="elsevierStyleHsp" style=""></span>mg/dL, urea 36. Urine analysis: proteinuria 20<span class="elsevierStyleHsp" style=""></span>mg/dL (0.6<span class="elsevierStyleHsp" style=""></span>g in 24<span class="elsevierStyleHsp" style=""></span>h). Renal ultrasound: normal. Serology and cross-match: negatives.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A right cadaver kidney was implanted in the right iliac fossa, with a prophylactic double J ureteral catheter with little diuresis after surgery. In the following hours, hemodynamic instability appeared. A renogram with <span class="elsevierStyleSup">99m</span>Tc-DTPA was performed at 24<span class="elsevierStyleHsp" style=""></span>h from surgery, presenting poor renal function and severe acute tubular necrosis. As the hemodynamic instability persisted, an ultrasound and abdominal CT were requested, confirming an abdominal hematoma that required surgery. During the admission, the delay in the graft function persisted with a significant fluid overload, requiring 7 sessions of hemodialysis. A new renogram with <span class="elsevierStyleSup">99m</span>Tc-DTPA was performed after 8 days. It showed:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Vascular phase: adequate perfusion of the renal graft.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Renographic phase: good parenchymal uptake compared to vascular background. There was activity in the renal pelvis and ureter that were discretely dilated (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Early and delayed planar images and delayed SPECT/CT study (<a class="elsevierStyleCrossRefs" href="#fig0025">Figs. 5 and 6</a>): three foci were observed, two of them perirrenal and the other one in the inguinal area in relation to urinary leakage.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">It was decided to perform a nephrostomy after the renogram. When the contrast was administrated, the double J catheter was not permeable, so it was reintroduced correctly. In the following days, there was an increase in the diuresis, progressive decrease of nitrogen products in the blood, as well as clinical and renal function improvement. After 10 days, the patient was discharged. Blood test: urea 86<span class="elsevierStyleHsp" style=""></span>mg/dL, Cr 2.7<span class="elsevierStyleHsp" style=""></span>mg/dL, glucose 95<span class="elsevierStyleHsp" style=""></span>mg/dL, Na 140<span class="elsevierStyleHsp" style=""></span>mEq/L, K 4.1<span class="elsevierStyleHsp" style=""></span>mEq/L, Cl 106<span class="elsevierStyleHsp" style=""></span>mEq/L.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The incidence of surgical complications after a kidney transplantation ranges between 2.5% and 14.7%, being the most common complications the ureteral stenosis and urine leak. Minor leaks are usually treated conservatively, but in the larger ones a surgical reconstruction of the ureterovesical anastomosis is often required.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There is a suspicion of the existence of a urinary leakage when urine production decreases, serum creatinine level increases, and there is a perirenal accumulation. Also it is common the presence of fever or urine in the surgical drainage tube.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The onset of the urinary leak occurs on average at 13.6 days (1–55 days), and usually before the fifth week post-transplantation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The most common location is the distal ureter (approximately 76%), usually caused by ureteral necrosis. Its onset causes a significant morbidity in the patient and may lead to loss of the graft or death of the recipient. The two main factors that influence the success of the ureterovesical anastomosis are the vascularization of the donor ureter and the surgical technique.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> A collection of perinephric fluid after renal transplantation may represent multiple etiologies, including urinoma, lymphocele, hematoma, or abscess.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Renogram and ultrasounds are the main non-invasive diagnostic tools for urinary leakage. Ultrasound can accurately locate fluid collections, but do not differentiate between collections of urine, lymph, pus or blood. Computed tomography can also be used, but iodinated contrast is limited in patients with renal failure. The isotopic renogram is a very useful test not only to confirm the presence of urine outside the urinary tract, but also to evaluate perfusion and renal function.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">99m</span>Tc-DTPA is the radiopharmaceutical of choice in most of centers instead of <span class="elsevierStyleSup">99m</span>Tc-MAG3. MAG3 is a radiopharmaceutical that allows to obtain high quality images in transplanted patients, but in approximately 2–10% hepatic avidity might occur (that increases with kidney failure) and is excreted in the biliary system. For this reason, delayed images with this radiotracer may conduct to false positive findings. Other cause of a false positive result can be explained by an unusual anatomy of the collecting system, a vesicoureteral reflux, or the presence of a drainage bag.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In general, a persistent photopenic defect in the delayed images probably represents hematoma, lymphocele, or abscess. On the other hand, a focus with an uptake higher than background that increases over time in the delayed images is probably due to an urine extravasation. When the urinary leak is small, the activity of the tracer may not be noticed in early images.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In contrast, as demonstrated in the two cases presented, the delayed images including a SPECT/CT acquisition are essential in the detection and localization of small urine leaks.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6–7</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1135718" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1067754" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1135719" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1067753" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical case 2" ] ] ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-10" "fechaAceptado" => "2018-07-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1067754" "palabras" => array:4 [ 0 => "Kidney transplantation" 1 => "Urinary leakage" 2 => "Isotopic renogram" 3 => "Allograft failure" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1067753" "palabras" => array:4 [ 0 => "Trasplante renal" 1 => "Fuga urinaria" 2 => "Renograma isotópico" 3 => "Fracaso renal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Urinary leakage in patients with kidney transplantation is a relatively common surgical complication that requires early diagnosis and intervention. The isotopic renogram is a non-invasive and effective method to evaluate the perfusion and function of kidney transplantation, and allows us to diagnose urological complications such as urinary leakage. In these cases, it is useful to complete the study with planar images and delayed SPECT/CT to specify the diagnosis and locate the leak. We expose two cases diagnosed with urinary leak after performing a renogram with early and delayed planar images and delayed SPECT/CT a week after transplantation. In both cases, a percutaneous nephrostomy catheter was placed, as well as a double J catheter, resolving the surgical complication.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La fuga urinaria en los pacientes trasplantados renales es una complicación quirúrgica relativamente frecuente que requiere un diagnóstico e intervención precoces. El renograma isotópico es un método no invasivo y efectivo para evaluar la perfusión y función del trasplante renal, y nos permite diagnosticar complicaciones urológicas como la fuga urinaria. En estos casos es de gran utilidad completar el estudio con imágenes planares y SPECT/TC tardío para precisar el diagnóstico y localizar la fuga. Se exponen 2 casos diagnosticados de fuga urinaria tras realizar renograma con imágenes planares precoz y tardía y SPECT/TC tardío, a la semana de ser sometidos a trasplante. En ambos casos se colocó una sonda de nefrostomía percutánea, así como un catéter ureteral doble J, resolviéndose la complicación quirúrgica.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez Hidalgo J, Ruiz Gómez MÁ, Gamazo Laherrán C, Alonso Rodríguez M, Sainz Esteban A, Ruano Pérez R. Renograma en trasplante renal. Utilidad de imágenes tardías con SPECT/TC para el diagnóstico de fuga urinaria. Rev Esp Med Nucl Imagen Mol. 2019;38:46–49.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1088 "Ancho" => 3167 "Tamanyo" => 271350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">99m</span>Tc-DTPA isotopic renogram. (A) Vascular phase. (B) Clearance phase: homogeneous distribution of the radiotracer inside the renal parenchyma. Activity in renal pelvis is visualized from the 7th minute, but there is no activity in the bladder after the first 30<span class="elsevierStyleHsp" style=""></span>min of the study. (C) Activity–time curve shows a flattened morphology in relation to acute tubular necrosis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1122 "Ancho" => 2167 "Tamanyo" => 111158 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Early and delayed planar images focused on pelvis performed at 30 and 120<span class="elsevierStyleHsp" style=""></span>min, respectively. Radiotracer activity is observed adjacent to distal third of ureter (black arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1613 "Ancho" => 3167 "Tamanyo" => 392045 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">SPECT/CT images performed 2<span class="elsevierStyleHsp" style=""></span>h after the administration of <span class="elsevierStyleSup">99m</span>TC-DTPA. The urinary leak described in case 1 is visualized (white arrow). An abnormal radiotracer accumulation is observed in the pelvic area that correlates in the CT images to a liquid collection in relation to urinary leakage.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1037 "Ancho" => 3167 "Tamanyo" => 273513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">99m</span>Tc-DTPA isotopic renogram. (A) Vascular phase. (B) Clearance phase: a good parenchymal uptake is observed. Renal pelvis and a mild dilation of the ureter is visualized from the 14th minute. (C) The activity–time curve shows an improvement of the acute tubular necrosis.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 969 "Ancho" => 2167 "Tamanyo" => 130419 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Early and delayed planar images focused on pelvis performed at 30 and 120<span class="elsevierStyleHsp" style=""></span>min. Radiotracer activity is visualized in the periureteral area (black arrow).</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1433 "Ancho" => 3167 "Tamanyo" => 378137 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Case 2: SPECT/CT performed 2<span class="elsevierStyleHsp" style=""></span>h after the administration of <span class="elsevierStyleSup">99m</span>Tc-DTPA. Three small foci of uptake are observed in relation to urinary activity. One focus is adjacent to the renal parenchyma and the drainage tube. Other uptake is located in the inguinal region, and the third focus is located below the lower pole of the graft (white arrow), compatible with an urinary leakage.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simple provocative maneuvers in renal transplant scintigraphy for detecting urine leak" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Dede" 1 => "T. Ones" 2 => "B. Caliskan" 3 => "H. Civen" 4 => "T.Y. Erdil" 5 => "S. Inanir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12149-007-0065-4" "Revista" => array:6 [ "tituloSerie" => "Ann Nucl Med" "fecha" => "2007" "volumen" => "21" "paginaInicial" => "603" "paginaFinal" => "606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18092138" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute and chronic allograft dysfunction in kidney transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.J. Goldberg" 1 => "F.L. Weng" 2 => "P. Kandula" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mcna.2016.01.002" "Revista" => array:6 [ "tituloSerie" => "Med Clin N Am" "fecha" => "2016" "volumen" => "100" "paginaInicial" => "487" "paginaFinal" => "503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27095641" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical complications of renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.O. Timsit" 1 => "F. Kleinclauss" 2 => "V. Richard" 3 => "R. Thuret" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.purol.2016.09.052" "Revista" => array:6 [ "tituloSerie" => "Prog Urol" "fecha" => "2016" "volumen" => "26" "paginaInicial" => "1066" "paginaFinal" => "1082" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27720313" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal transplantation: technical aspects, diagnosis and management of early and late urological complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Greco" 1 => "P. Fornara" 2 => "V. Mirone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Panminerva Med" "fecha" => "2014" "volumen" => "56" "paginaInicial" => "17" "paginaFinal" => "29" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24637470" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small urine leak after renal transplantation: detection by delayed 99mTc-DTPA renography – a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.Q. Yu" 1 => "H. Zhuang" 2 => "Y. Xiu" 3 => "G. El-Haddad" 4 => "R. Kumar" 5 => "A. Alavi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Nucl Med Technol" "fecha" => "2005" "volumen" => "33" "paginaInicial" => "31" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15731018" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urinary leak after renal transplantation proven by SPECT-CT imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Talanow" 1 => "D. Neumann" 2 => "R. Brunken" 3 => "B. Bybel" 4 => "G. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0b013e318156bb43" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "883" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18075430" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic dilemma of urinary leak vs. perirenal abscess on skeletal scintigraphy: the added value of SPECT/CT and renal scintigraphy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.K. Jain" 1 => "R.K. Basher" 2 => "B.R. Mittal" 3 => "A. Bhatia" 4 => "S.K. Singh" 5 => "A. Bhattacharya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2015.05.004" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "48" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26139031" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003800000001/v1_201901110618/S2253808918301022/v1_201901110618/en/main.assets" "Apartado" => array:4 [ "identificador" => "76945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003800000001/v1_201901110618/S2253808918301022/v1_201901110618/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918301022?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 May | 4 | 0 | 4 |
| 2024 April | 1 | 2 | 3 |
| 2023 March | 1 | 0 | 1 |
| 2022 September | 1 | 0 | 1 |
| 2021 November | 1 | 2 | 3 |
| 2020 November | 27 | 2 | 29 |
| 2019 October | 2 | 2 | 4 |
| 2019 September | 1 | 2 | 3 |
| 2019 February | 1 | 0 | 1 |
