Normal sonographic findings of a renal transplant include...

• A. Prominent renal pyramids
• B. Hydronephrosis
• C. Renal cortical thinning
• D. Perinephric fluid collection

Answer: (A)

The main idea here is recognizing what a normal post-transplant kidney can look like on ultrasound. In a functioning renal allograft, the cortex should be preserved and corticomedullary differentiation should be visible. The medullary pyramids can appear more conspicuous in a transplant due to the cortex often being relatively thinner in the transplanted graft and the iliac fossa position, so the pyramids stand out on the ultrasound. This pattern can be seen without indicating pathology, making prominent renal pyramids a normal finding in this setting.

Hydronephrosis would suggest a drainage problem or obstruction, which is not a normal finding in a healthy graft. Renal cortical thinning points to chronic injury or rejection and would raise concern for graft dysfunction. Perinephric fluid collections can occur after surgery (e.g., lymphocele), but they are not considered a normal long-term finding and warrant evaluation if present.