Contribution of 99mTc-DTPA scintigraphy with diuretic test in the exploration of acute urinary obstruction in a transplant patient

摘要

Urinary tract obstruction is a threat for graft function. Routine ultrasound can be important for early detection of problems in the postoperative period, but its findings can be at the origin of false-negative in the mild dilatation of calyces and renal pelvis. In the current case, 99mTc-DTPA dynamic renal scintigraphy with diuretic test, as a functional modality, was very helpful in early diagnosis of organic obstruction. It allowed moreover directing the therapy while evaluating its effectiveness a few weeks afterwards. Introduction Renal transplantation is the best available treatment for most patients with end stage renal disease. However, serious surgical complications can occur after renal transplantation like urinary obstruction. Its early diagnosis should be performed to prevent permanent damage to the kidney. The current case presents the value of diuretic DTPA-Tc99m renal scintigraphy in the detection of acute urinary obstruction in renal transplantation. Case report 26 years old man patient followed for a chronic renal failure at a final stage having profited from a renal transplantation starting from an alive donor. The immediate operational continuations were satisfactory. In fact, on the postoperative first day, urinary output was 3100 ml and blood creatinine level 13 mg/l. The evolution was marked 4 weeks after the transplantation by a moderate diuresis reduction while creatinine was slightly increased to 19 mg/l. Renal ultrasonography was carried out and showed no important abnormality. There was a light dilatation of calixiel groups and pelvic distension with a preserved cortical index. Intravenous urography revealed a dysrotation of the right renal graft and confirmed the light pelvic and calix distension (figure 1).