Perirenal Fluid Collection Research Articles

Abscess Drainage in the Genitourinary Tract

This article deals with the diagnosis of perirenal fluid collections as well as renal abscesses. Proper diagnostic and drainage techniques are discussed, as are patient selection, route selection, catheter selection, technique, and catheter management. In addition, the cure rates of the therapeutic procedure are reviewed.

Role of ultrasound in renal transplantation.

Ultrasound examination of a renal transplant was performed in 27 patients over a period of 28 months; there were kidneys from 12 living and 15 cadaveric donors. The ultrasonic scans were performed over a period ranging from 2 days to 12 years following transplantation. We were able to observe and describe the echographic findings of the normal evolution of a well functioning renal transplant, acute tubular necrosis, acute and chronic rejection, perirenal fluid collection, and obstructive uropathy. Ultrasound evaluation of renal transplant was accurate in the diagnosis of postoperative complications together with clinical and laboratory findings. Ultrasound imaging is independent of renal function and can be performed quickly as often as necessary. Percutaneous procedures, including fine needle aspiration, biopsy, aspiration of fluid collection, and positioning of the pyelostomy catheter can be performed under ultrasonic guidance.

Acute post-transplantation renal failure: differential diagnosis by ultrasound.

Sonograms of 35 patients with cadaveric renal allografts were reviewed. The patients included five with successful renal transplantations, seven with acute tubular necrosis, 19 with acute rejection, one with complete occlusion of the renal artery, and three with stenosis of a renal artery. During the course of acute tubular necrosis, the renal anatomy remained sonographically unaltered. During the course of acute rejection, there was a spectrum of sonographic findings including increase in renal volume, decreased amplitude of the renal sinus echoes, enlarged medullary pyramids, indistinct corticomedullary boundary, increased echogenicity of the renal cortex, areas of decreased parenchymal echogenicity, sparse cortical echoes, and perirenal fluid collections as a result of hematoma or crescentic collection of fluid around the kidney. In both arterial occlusion and stenosis, no sonographic abnormalities of renal anatomy were seen and the only finding was lack of normal post-transplantation hypertrophy. Our study encourages the use of sonography in acute post-transplantation renal failure. If serial ultrasound studies are available and correlation with clinical and laboratory data and nuclear medicine studies are obtained, the correct diagnosis may be reached without the use of invasive procedures.

The Role of Ultrasound in the Diagnosis of Kidney Allograft Rejection

Seventeen nephrectomized dogs underwent kidney transplantation from unrelated donors. Routine immunosuppressive therapy was administered. Serial ultrasound studies and biopsies and complete pathological examinations were performed and compared. A number of sonographic changes were observed within the renal parenchyma during rejection, some of which were present before a significant rise in serum creatinine levels. The medulla became enlarged due to edema, followed by growth of the rest of the kidney and thickening of the cortex. The cortical echoes became more sparsely distributed and either increased or decreased in amplitude; distribution was generalized or localized. During rejection, the corticomedullary boundary became indistinct. Later, a decrease in the renal sinus echoes was also noted. In 2 cases, perirenal fluid collections occurred as the result of renal rupture.

Ultrasonic Testing in Human Renal Allografts

B-scan ultrasonography was used as an aid in the evaluation of 15 human renal allotransplantations. Repeated studies detect changes in the kidney outline and the kidney cross-section, and the presence of abnormal acoustic interfaces in the perirenal areas. Over 70 studies were completed in this series. Of six cases of graft injection with functional, angiographic, radioactive isotope, and histologic confirmation, four showed a corresponding increase in size by ultrasonic laminography during the acute rejection phase, with reversal following correction of rejection. Seven cases of perirenal fluid collection caused by either lymph or other fluids were generally asymptomatic but were confirmed in four cases by subsequent clinical studies. They were initially discovered by this technique. Ultrasonic laminography is readily adaptable for the initial and follow-up evaluation of patients undergoing human renal allotransplants.