Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. On-going urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life, reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.

Patients with primary focal segmental glomerulosclerosis (FSGS) have a high risk of disease recurrence post renal transplantation; this is usually characterised by significant proteinuria and associated with poor graft survival. FSGS recurrence is a challenging medical condition, not only because there is no recognised predictor of FSGS recurrence in the allograft, but also because there are no available international guidelines for treatment of this condition which add more mystery to the dilemma created by this vague syndrome.Our work aimed to draw the attention to the latest available evidence addressing recurrence of FSGS in the renal allograft, in an attempt to improve our understanding of this condition. This also helps to guide the future studies towards the promising approaches in diagnosis and management of this condition. Ultimately this will result in better graft survival and lower the demands for another renal transplant giving the universal shortage of transplantable organs.

Patients with primary focal segmental glomerulosclerosis (FSGS) have a high risk of disease recurrence post renal transplantation; this is usually characterised by significant proteinuria and associated with poor graft survival. FSGS recurrence is a challenging medical condition, not only because there is no recognised predictor of FSGS recurrence in the allograft, but also because there are no available international guidelines for treatment of this condition which add more mystery to the dilemma created by this vague syndrome. Our work aimed to draw the attention to the latest available evidence addressing recurrence of FSGS in the renal allograft, in an attempt to improve our understanding of this condition. This also helps to guide the future studies towards the promising approaches in diagnosis and management of this condition. Ultimately this will result in better graft survival and lower the demands for another renal transplant giving the universal shortage of transplantable organs.

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