A 48-year-old woman, hypertensive, diabetic and dyslipidemic, with chronic kidney disease underwent a kidney transplant from a cadaveric donor.
Fifty-seven days later, the patient presented correct renal function with creatinine of 1 mg/dl and no proteinuria.
Twenty-six months after transplantation, the patient complained of general malaise, hypoxia, epigastric pain, vomiting and diarrhea lasting 3-4 weeks.
He had blood pressure (BP) 156 mmHg, heart rate 82 bpm, and oliguria.
Acute renal failure was evidenced with creatinine of 12 mg/dl, metabolic acidosis and hyperkalemia (6.75 mmol/l).
Initially, it was oriented as acute renal failure secondary to acute graft rejection due to oral medication intolerance, since infratherapeutic tacrolimus plasma levels were observed.
Under this suspicion corticoid treatment was initiated and renal biopsy was performed for histological diagnosis, which showed lesions compatible with acute cellular rejection type I of the Banff classification.
At the time of biopsy, the patient had a creatinine level of 3.51 mg/dl and a glomerular filtration rate (GFR) of 15%.
After the biopsy, the patient presented a picture of hematuria with clots, without presenting obstructive symptoms.
A renal echo-ppler showed a hematoma in the middle lobe with arterial flow inside, an inlet arcade and an outlet suggestive of AVF.
Selective femoral renal artery catheterization was performed with a Vanschie catheter.
Angiography showed a high output segmental renal branch AVF and two other less dependent entities, all of them at the mid-third of the kidney.
Catheterization of the affected renal branch was performed, releasing two microcoils (C) of 0.5 cm to treat high output fistula.
The two remaining fistulas were spontaneously thrombosed after catheterization of the affected branch with multipurpose catheter and prior to additional release of microcoils.
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Verification angiography showed correct patency of the remaining renal branches and perfusion of the parenchyma.
At this time the patient had creatinine of 5.23 mg/dl and GFR of 9%.
It showed good BP control, between 120-139/70-85 mmHg, and diuresis greater than 1800 ml/day.
The post-procedural evolution was satisfactory, with no recurrence of hematuria, progressive improvement of renal function (at two months, creatinine of 2.84 mg/dl and GFR of 20%) and pseudoaneurysm resolution.
