Diagnosis Of Acute Rejection

Clinical picture

Fever, weight gain, enlargement and tenderness of graft, hypertension, reduced urinary output, decreased renal function, reduced urinary sodium excretion, and increased proteinuria Cyclosporine trough blood level When these levels are higher than expected, cyclosporine nephrotoxicity is suspected; however, this does not rule out rejection—very low levels, in the presence of elevated serum creatinine, suggest acute rejection, perhaps as a result of noncompliance Radionuclide renal studies

Provide information about blood flow and the excretion index, and aid in excluding extravasation and obstruction Renal sonography with Doppler ultrasonography Provides information about kidney size, renal blood flow, corticomedullary differentiation, pyramid shape, and the collecting system; establishes the diagnosis of obstruction, extravasation, and renal artery stenosis Renal arteriogram

Establishes the diagnosis of major renal vessel stenosis or occlusion Magnetic resonance imaging

Establishes the diagnosis of obstruction, renal vessel stenosis, or occlusion; aids in evaluating the corticomedullary junction and pyramid shape Fine-needle aspiration biopsy

Identifies inflammatory cells in the graft, tubular damage, cyclosporine toxicity, and cytomegalovirus infection; aids in differentiating rejection, acute tubular necrosis, cytomegalovirus infection, and cyclosporine nephrotoxicity Renal biopsy

Remains the gold standard for determining rejection and cyclosporine nephrotoxicity

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