1. Quiz page answers May 2005 American Journal of Kidney Diseases
American Journal of Kidney Diseases 
Volume 45, Issue 5, Pages e73-e74 (May 2005)
DOI: /j.ajkd
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2. Figure 39A
What do you observe on this computed tomographic scan of the kidney transplant?
The image shows a large renal infarction. Renal color flow Doppler also confirmed the absence of arterial blood flow in the upper pole of the grafted kidney.
American Journal of Kidney Diseases  , e73-e74DOI: ( /j.ajkd )
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3. Figure 39B Magnetic resonance image of the kidney transplant.
Gadolinium magnetic resonance imaging confirmed a large, wedge-shaped, cortically based, non-enhancing area, without corticomedullary differentiation.
Pain in a kidney transplant can occur, despite the fact that the allograft is denervated at the time of transplantation. The problem of kidney allograft thrombosis is an ongoing challenge in transplantation. The proportion of grafts lost to thrombosis is increasing, in part due to the dramatic reduction in the number of grafts lost to acute rejection, and in part due to the use to extended-criteria donors.
Most often, graft thrombosis occurs in the first few hours or days after kidney transplantation. The pathogenesis is multifactorial and reflects a combination of an initiating lesion located in the grafted kidney, facilitated by a thrombophilic milieu in the recipient. Often there is a predisposing factor, such as horseshoe kidney or multiple vessels, but kidney infarction also occurs as an isolated finding.
In native kidneys, a large renal infarction—like the one in our patient’s graft—is usually severely symptomatic (presenting with sudden onset of flank pain, hematuria, proteinuria, fever, leukocytosis, and high lactate dehydrogenase levels). The symptoms occurring in the renal graft are somehow less specific, particularly in late-occurring infarction, as in the case reported here.
Interestingly, this patient had no acute increase in serum creatinine or hematuria. This case, combining most of the vascular risk factors of both donor and recipient (long renal replacement history, hypertension, older donor age, and delayed graft function), suggests that we should consider acute allograft vascular events in the differential diagnosis of acute abdominal pain in renal transplant patients, particularly with relatively old donors and recipients.
American Journal of Kidney Diseases  , e73-e74DOI: ( /j.ajkd )
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