KEY FACTS
Imaging
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Enlarged, edematous, hypoechoic kidney due to outflow obstruction
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Absence or decreased color flow in renal vein at hilum
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Patent renal artery early, later renal artery will thrombose also
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High systolic arterial peaks with flow reversal in diastole
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Color, power, spectral Doppler US is 1st-line imaging modality for complications of renal transplantation
Top Differential Diagnoses
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Acute, severe rejection or delayed graft function
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Iliac vein thrombosis or renal vein compression
Pathology
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Surgical injury or technical problem
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Compression by fluid collection
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Hypovolemia, hypercoagulable state
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Thrombus propagation from common femoral/external iliac vein
Clinical Issues
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Abrupt onset of graft tenderness and swelling, decreased function
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Usually within 1st week, most commonly within 48 hours of transplantation
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≤ 4% of transplants
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Poor prognosis even with prompt diagnosis and thrombectomy/surgical revision
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May progress to rupture with hemorrhage and hypovolemia
Diagnostic Checklist
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Consider renal vein thrombosis when there is sudden drop in urine output in early postoperative period
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Reversal of arterial diastolic flow and absence of venous flow confirms this diagnosis
