Renal Failure, Renovascular Disease, and Renal Transplantation Imaging — WACS Viva & Clinical Scenarios (Genitourinary and Retroperitoneal Imaging)

Exam-style renal failure, renovascular disease, and renal transplantation imaging viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: A 52-year-old male with resistant hypertension and progressive renal function decline is referred for renal vascular assessment. Describe your systematic duplex Doppler interrogation protocol for native renal artery stenosis, detailing direct and indirect spectral parameters used to establish haemodynamically significant stenosis.
• SCENARIO 2: A 38-year-old female presents on postoperative day 18 following a live-donor renal transplant with oliguria, rising serum creatinine, and ipsilateral lower limb swelling. Outline the ultrasound and Doppler features used to differentiate between post-transplant fluid collections and formulate a prioritized differential diagnosis.
• SCENARIO 3: An ultrasound of a renal allograft performed 24 hours post-implantation in a patient with sudden anuria demonstrates graft enlargement and biphasic arterial spectral Doppler waveforms with complete reversal of diastolic flow. Explain the underlying vascular catastrophe, the differential diagnoses, and your immediate interventional or reporting actions.
• SCENARIO 4: A 46-year-old patient on maintenance haemodialysis for 7 years undergoes abdominal computed tomography for painless macroscopic haematuria. Detail the imaging features of acquired cystic disease of the kidney (ACDK), the differentiation of benign uremic cysts from renal cell carcinoma, and the role of unenhanced versus contrast-enhanced CT and MRI in renal impairment.
• SCENARIO 5: A 28-year-old female presents with malignant hypertension and an epigastric bruit. Detail the differences in demographic distribution, vascular localization, and angiographic appearances between atherosclerotic renal artery stenosis and fibromuscular dysplasia (FMD), and state the criteria for diagnosing post-biopsy arteriovenous fistula (AVF) and pseudoaneurysm.