DIAGNOSIS OF RENAL-TRANSPLANT FAILURE BY REAL-TIME AND DUPLEX-DOPPLERSONOGRAPHY

A total of 419 real-time and duplex Doppler ultrasound examinations of renal allografts were carried out in 61 patients. Results were relate d to the clinical diagnoses based on histomorphological, clinical, and laboratory findings. The results of all sonographic examinations in t erms of the diagnostic parameters of normal function, acute tubular ne crosis, and interstitial and vascular rejection did not yield reliable criteria for distinguishing between the different forms of transplant dysfunction. The maximum difference was calculated for each ultrasoun d parameter between a time of normal transplant function and at a time of dysfunction. By means of this 'maximum parenchyma-pyelon index dif ference' it was possible to discriminate between acute tubular necrosi s and vascular rejection (P<0.05). Acute tubular necrosis could be dis tinguished from interstitial rejection using the maximum longitudinal renal diameter difference and the maximum parenchyma-pyelon index diff erence (P<0.05). To discriminate between interstitial and vascular rej ection the maximum pulsatility index difference was very useful (P<0.0 5). Combined real-time and duplex Doppler sonography is most valuable in the diagnosis of transplant failure when it is performed not only i n the case of dysfunction but also when transplant function appears to be normal.