Functional Evaluation of Human Kidney Transplants with Renograms

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Abstract
Serial renograms after kidney transplantation in 21 patients were analyzed. Normal renograms may be obtained in renal transplants. Persistence of normal tracings over a prolonged period has been observed thus far only in recipients of grafts from identical twins. Improvement or deterioration of renogram configuration parallels similar changes in other renal function tests, especially creatinine clearance, blood urea nitrogen and urine osmolality. Although no specific alteration of renogram configuration is characteristic of the rejection phenomenon, a flattening in the slope of phase two has invariably accompanied significant rejection. In the presence of adequate proximal tubular function, urinary obstruction produces characteristic changes which may differentiate this problem from rejection or vascular accident. Viability of the graft has been demonstrated despite oliguria or anuria. A definite diagnosis of graft infarction cannot be made by renograms alone, although it may be strongly suspected when phases two and there are absent. Renograms have their greatest value when performed serially. They may be particularly useful, however, when a sudden alteration occurs in the clinical status of the graft. Incipient homograft rejection, ureteral obstruction, infarction of the kidney and acute tubular necrosis are all specific conditions in which renography can be a valuable adjunct.