A Case of Very Early Kidney Allograft Dysfunction Suwasin Udomkarnjananun, Somrath Srijaruneruang, Natavudh Townamchai, Kroonpong Iampenkhae, Wipusit Taesombat, Yingyos Avihingsanon, Kearkiat Praditpornsilpa  American Journal of Kidney Diseases  Volume 73, Issue 6, Pages A10-A14 (June 2019) DOI: 10.1053/j.ajkd.2018.12.030 Copyright © 2019 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Doppler ultrasound of allograft on day 1 after transplantation. American Journal of Kidney Diseases 2019 73, A10-A14DOI: (10.1053/j.ajkd.2018.12.030) Copyright © 2019 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Allograft biopsy on day 5 after transplantation. American Journal of Kidney Diseases 2019 73, A10-A14DOI: (10.1053/j.ajkd.2018.12.030) Copyright © 2019 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Venous phase of kidney allograft computed tomographic scan, axial view. White arrow shows thrombus along the renal vein and right external iliac vein. Given the lack of contrast excretion, the nephrogram of the transplanted kidney was absent. American Journal of Kidney Diseases 2019 73, A10-A14DOI: (10.1053/j.ajkd.2018.12.030) Copyright © 2019 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Venogram of the transplanted renal vein. (A) There is a large filling defect in the anastomosis of the transplanted renal vein and external iliac vein (black arrow), consistent with the location of the thrombus from the computed tomographic scan. (B) After intralesional thrombolysis was attempted, the transplanted renal vein was cannulated, but multiple filling defects were still visible in the vein (white arrows). Note that the architecture of the transplanted kidney was lost. American Journal of Kidney Diseases 2019 73, A10-A14DOI: (10.1053/j.ajkd.2018.12.030) Copyright © 2019 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 Transplanted kidney pathology. (A) Renal vein with recent thrombus, which exhibits alternating pale pink bands of platelets with fibrin and red bands of red blood cells. (B) Total coagulative necrosis of the renal parenchyma. Glomeruli and peritubular capillaries show prominent and diffuse vascular congestion with focal infiltration of neutrophils in some areas. American Journal of Kidney Diseases 2019 73, A10-A14DOI: (10.1053/j.ajkd.2018.12.030) Copyright © 2019 National Kidney Foundation, Inc. Terms and Conditions