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CASE REPORT
A reversible cause of ‘end-stage renal disease’: discrepant findings in serial duplex ultrasonograms in a suspected occlusion of a renal arterial bypass graft
  1. Ashvin Baru1,
  2. Eric Scott Kerns2,
  3. David M Cohen3
  1. 1Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
  2. 2Department of Nephrology, Rhode Island Hospital, Providence, Rhode Island, USA
  3. 3Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University and the Portland VA Medical Center, Portland, Oregon, USA
  1. Correspondence to Dr Eric Scott Kerns, ekerns{at}lifespan.org

Summary

Duplex ultrasonography may be inaccurate due to a number of variables in operator and patient characteristics. We describe a 40-year-old woman who presented with acute kidney injury after prior complex abdominal aortic surgery that had left her with an essentially solitary functional kidney. On the basis of normal Doppler findings, she was started on dialysis. Owing to high clinical suspicion and a failure of renal function to return, a second Doppler study was performed 3 weeks after the first, revealing the characteristic tardus–parvus waveform of renal artery stenosis. The patient underwent urgent renal arterial angioplasty and stent placement. She experienced an immediate increase in urinary output, required no further dialysis, and the creatinine improved to 1.7 mg/dL (her prior renal baseline). The case illustrates an important complication of abdominal aortic aneurysm repair, draws attention to a potential source of error in the Doppler measurement, and underscores the limitations of duplex ultrasonography for excluding renal artery stenosis in the presence of high pretest probability.

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