Kidney donor evaluation with helical CT angiography

Sydney Tang, Tak Mao Chan and Kar Neng Lai

Department of Medicine University of Hong Kong Queen Mary Hospital Hong Kong, China

Sir,

We read with interest the article by Patil et al. [1] reporting on the use of helical CT angiography in evaluating living renal donors (LRD). We have previously compared the accuracy of helical CT angiography with conventional renal arteriography in the evaluation of Chinese LRD subjects, and found a much lower incidence of multiple renal arteries (11% vs 25.5%) with equal distribution on each side [2]. In the report by Patil et al. [1], the apparently higher incidence of multiple vessels in the left kidney (31% vs 20% on the right) could well be due to sheer chance, noting the lack of statistical data, and that another report [3] on Caucasoid subjects showed no side preference for the occurrence of multiple renal arteries.

Apart from delineation of vascular anatomy to decide which kidney is most amenable to harvesting and transplantation, another value of subjecting potential LRD to angiography is to diagnose unsuspected renal vascular and parenchymal diseases. While we agree that helical CT may have its limitation in detecting fibromuscular dysplasia, we wish to point out that it may be superior in diagnosing solitary ostial renal artery stenosis that may be totally missed by conventional arteriography [2]. This is because CT eliminates catheter-related error, which invariably occurs with selective renal arteriography, especially when there is a low clinical index of suspicion, such as in the pre-operative work up of normotensive LRD candidates.

While it is true that CT angiography involves a larger amount of radiocontrast than conventional arteriography, we do not agree that there is an increased risk of nephrotoxicity with the former. The smaller contrast volume injected directly into the renal arteries during conventional arteriography may have similar, if not higher, nephrotoxic potential due to its higher local concentration within the kidney than the larger volume used intravenously during CT angiography. In our cohort, serum creatinine levels were unchanged after either radiographic investigation [2]. Another advantage of CT over invasive angiography not mentioned by the authors is that total radiation exposure, particularly to staff, is conceivably much lower.

Notes

Email: knlai{at}hkucc.hku.hk Back

References

  1. Patil UD, Ragavan A, Nadaraj et al. Helical CT angiography in evaluation of live kidney donors. Nephrol Dial Transplant2001; 16: 1900–1904[Abstract/Free Full Text]
  2. Tang S, Chan J, Tso WK, Ho KK, Chan TM, Lai KN. Helical computed tomography angiography in the evaluation of Chinese living renal donors. BJU Int1999; 83: 387–391[ISI][Medline]
  3. Rubin GD, Alfrey EJ, Dake MD et al. Assessment of living renal donors with spiral CT. Radiology1995; 195: 457–462[Abstract]




This Article
Extract
FREE Full Text (PDF)
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in ISI Web of Science
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Search for citing articles in:
ISI Web of Science (1)
Disclaimer
Request Permissions
Google Scholar
Articles by Tang, S.
Articles by Lai, K. N.
PubMed
PubMed Citation
Articles by Tang, S.
Articles by Lai, K. N.