Orthostatic Renal Transplant Compression Following Weight Gain Leading to Acute Kidney Injury

Abstract

BackgroundWe present a first case of orthostatic renal graft compression and acute kidney injury following weight gain. Case ReportA 61-year-old male with a second cadaveric transplant presented with acute kidney injury - creatinine rise from 80 to 210 μmol/L (0.90 to 2.38 mg/dL). His medical history included diabetes, hypertension, ischemic heart disease, and obesity despite bariatric surgery. Renal biopsy was consistent with acute tubular necrosis. Serial renovascular duplex studies showed absence of diastolic flow and reduced renal perfusion despite a patent renal transplant artery and vein. Raising the fatty apron cephalad normalized renal blood flow with resistive indices throughout the kidney. Subsequent laparascopy ruled out adhesional obstruction and carbon dioxide angiogram confirmed normal transplant vessels, anastomotic sites, and intrarenal branches. He was treated with bedrest and an abdominal support belt with improvement of creatinine to 100 to 110 μmol/L (1.1-1.2 mg/dL). ConclusionsTransplant physicians and surgeons need to be aware of positional renal graft compression from an enlarged bulky omentum and fatty apron. Diagnosis requires positional sonography.