An Unusual Cause of Abdominal Bruit

A 67-year-old male with a history of stage 5 chronic kidney disease and pre-emptive living unrelated kidney transplant 8 years prior presented to the clinic with a loud abdominal bruit, 2+ bilateral lower extremity edema, and hypertension. Laboratory evaluation revealed a serum creatinine at baseline levels of 2.5 mg/dL and microscopic hematuria on urinalysis. His post-transplant history was notable for BK virus nephropathy and persistent proteinuria, prompting four transplant biopsies, which ultimately demonstrated recurrent immunotactoid glomerulonephritis. Urine output remained normal. Follow-up imaging with color duplex ultrasonography is shown (Fig. 1).