Renal Dynamic Scintigraphy As a Sensitive Tool for Detecting Small Volume Urinoma Following Live-Related Renal Transplant

Renal transplant (RT) is the preferred treatment modality in patients with end-stage renal disease (ESRD). However, it is associated with a significant rate of complications. Early diagnosis and management of these complications are essential to prevent graft loss. Herein, we describe a case of a 48-year-old male who developed ESRD due to underlying autosomal-dominant polycystic kidney disease and underwent an RT. A routine renal dynamic scintigraphy (RDS) performed on day 4 posttransplant showed a focal minute area of radiotracer accumulation on the delayed static images raising suspicion for urinoma. However, it was deemed normal considering the normal renogram curve and stable clinical condition of the patient. However, on day 9 posttransplant, in view of clinical deterioration marked by decreasing urine output and rising serum creatinine levels, ultrasonography - kidney, ureter, and bladder (USG-KUB) and a repeat RDS were performed. Although the USG-KUB described a peri-nephric fluid collection, the nature of the collection could not be determined. RDS confirmed that the collection was urinoma. On retrospective analysis, the focal area of increased radiotracer uptake corresponded to the site of initial suspicion, although there was an increase in the size of the same. In experienced hands, RDS thus proves to be a highly sensitive tool for the diagnosis of urinoma, much before the clinical complications set in.