ESPN 51th Annual Meeting

ESPN 2018


 
A COMPLICATION OF PROTOCOL RENAL ALLOGRAFT BIOPSY: FORMATION AND MANAGEMENT OF ARTERIOVENOUS FISTULA
FATMA MUTLUBAŞ 1 AHMET ERGİN ÇAPAR 3 EREN SOYALTIN 1 BELDE KASAP DEMİR 2 CANER ALPARSLAN 1 ÖNDER YAVAŞCAN 1 SEÇİL ARSLANSOYU ÇAMLAR 1 DEMET ALAYGUT 1

1- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
2- IZMIR KATIP ÇELEBI UNIVERSITY DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
3- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF INTERVATIONAL RADIOLOGY , IZMIR, TURKEY
 
Introduction:

Arteriovenous fistula, a complication that can be encountered after renal biopsy, can rarely cause serious, long-lasting hemorrhage and even kidney allograft loss. Herein we present a case, was admitted with macroscopic hematuria on the 4th day of renal allograft biopsy and diagnosed as arteriovenous fistula by renal doppler ultrasonography.

Material and methods:

A 17-year-old male patient who underwent renal transplantation in 2016, was hospitalized for protocol biopsy in the second year post transplantation. Allograft biopsy was completed without any complication and any pathological findings in the laboratory and screening. On the fourth day after the biopsy, he admitted to hospital with abdominal pain and macroscopic hematuria. It was learned that the patient lifted a load of about 90 kilograms and get it on the roller coaster in unfair. The general medical condition and the vital findings were stable. On physical examination there were abdominal pain and tenderness. Laboratory findings revealed anemia (hb: 7.3 gr/dl) and high levels of serum creatinine (3.7 mg/dL).

Results:

Urinary system ultrasonography revealed grade 2 pelvicalectasis in transplant kidney and widespread hematoma in the bladder. A formation of AV fistula in the middle pole of kidney were suggested by renal doppler ultrasonography. Angiogram by interventional radiology clinic revealed two A-V fistulas between the distal branches of renal arteria. The arterial branches were catheterized with the aid of a microcatheter and embolization was performed with 2 microcoils. A check angiogram revealed an obliteration of the flow across the fistulous communication. The control color Doppler USG revealed normal findings and blood creatinine level decreased to baseline level (1.0 mg/dl.) of the patient.

Conclusions:

 AV fistula is a complication that can occur after kidney biopsy. Successful results can be obtained with microcoil embolization in the treatment. Patients undergoing biopsy should be informed of the activity restriction for the first week after biopsy.