Kidney allograft venous obstruction from polycystic kidney disease
Bibliographic record
Abstract
A 63-year-old woman, a kidney transplant recipient of a deceased donor kidney from 5 years prior, was seen in routine follow-up in the transplant clinic with progressively worsening graft function, along with bilateral leg edema and abdominal discomfort over a few weeks to months onset. Her native kidney disease was polycystic kidney disease. Maintenance immunosuppression consisted of tacrolimus, mycophenolate, and prednisone. Her post-transplant course had been remarkable for ureteric obstruction due to ischemic stenosis and calcification at 3 months post-transplant, which had required ureteric reconstruction and reimplantation. She also had cytomegalovirus viremia 9 months post-transplant (cytomegalovirus mismatch donation), which resolved with valganciclovir treatment. The rest of her course had been unremarkable, and her baseline creatine level was between 100 and 110 μmol/L. On presentation, her creatinine level was 136 μmol/L, and this progressively increased to 197 μmol/L over about a month. A contrasted computed tomography scan of the abdomen and pelvis was done for her abdominal discomfort and to rule out hydronephrosis. This revealed venous obstruction of the inferior vena cava (Figure 1) and venous outflow obstruction of the allograft due to a markedly enlarged native right polycystic kidney (Figure 2). She was admitted to the hospital, where she underwent urgent native right nephrectomy. The kidney measured 22 × 14 × 10 cm (Supplementary Figure S1). After nephrectomy, leg edema rapidly resolved and serum creatinine level markedly improved to 136 μmol/L on postoperative day 3 and then to 115 μmol/L on follow-up in the clinic at 1-week postnephrectomy. Leg edema had completely resolved. Venous obstruction from enlarged polycystic kidneys has been described in the nontransplant population; however, obstruction compromising venous outflow from a kidney allograft is an extremely rare occurrence. This case is a reminder to always consider the patient’s native disease when faced with worsening kidney allograft function, even when the native disease is polycystic kidney disease, which is not typically thought to cause direct allograft injury.Figure 2Venous obstruction of kidney allograft. Three-dimensional reconstruction of coronal computed tomography shows congested renal vein of the transplant kidney (yellow arrow), secondary to venous outflow obstruction due to severe inferior vena cava compression.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The patient provided verbal consent for this report. Download .docx (.47 MB) Help with docx files Supplementary File (Word) Figure S1. Postnephrectomy, macroscopic view of enlarged polycystic kidney.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".