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Abstract

A 67-year-old man presented to the emergency department 22 hours after a trauma to his kidney graft. He was asymptomatic during the first 10 hours, then he became anuric. His serum creatinine level was 2.73 mg/dL (baseline, 0.7 mg/dL), and his hemoglobin concentration was 13.1 g/dL. Computer tomography showed a 4-cm subcapsular hematoma without active bleeding. He underwent urgent decompression of the hematoma, and we did not find any active bleeding or parenchymal laceration. Urinary output had already recovered by the end of surgery without early or late complications. In conclusion, subcapsular hematoma, complicating a traumatic event on a kidney graft, can lead to a progressive parenchymal compression resulting in anuria. So, although in the absence of anemia, such events require urgent surgical decompression. Symptoms cannot be immediate, so all the graft trauma should be investigated with early ultrasound. Little is known in the case of major renal trauma but mildly symptomatic. Probably surgical exploration is better than observation to prevent possible early and late complications such as organ rejection or a Page kidney. Key words: Bleeding, Kidney transplant, Surgery IntroductionRenal transplant is the preferred treatment for endstage renal disease. Because of its low abdominal location, renal allografts lose the structural support offered to the native kidney by the thoracic wall and paraspinal musculature. For this reason, the transplanted kidney seems to be more vulnerable to traumatic damage. But there is a paucity of reports that deal with managing such an event. Case ReportA 67-year-old man presented to the emergency department 22 hours after a bicycle accident. The patient had undergone a renal transplant into right iliac fossa in 2002 because of chronic glomerulonephritis. Serum creatinine stabilized at 0.7 mg/dL. The patient's immunosuppressive drug regimen included only tacrolimus. In the first 10 hours after the accident, he did not experience any particular symptoms, but upon arrival at the emergency department, the patient said he had mild abdominal pain and anuria in the last 12 hours. His blood pressure was 110/70 mm Hg, his hemoglobin concentration was 13.1 g/dL, and his renal function was significantly impaired, with a serum creatinine level of 2.73 mg/dL.A physical examination revealed diffuse moderate abdominal tenderness. An ultraso nography scan demonstrated extensive periallograft hematoma and high renal arterial resistive indexes, with an empty bladder and no dilation of the upper urinary tract. A computed tomography scan revealed a 4-cm subcapsular hematoma without active bleeding (Figure 1). Urgent decompression of the hematoma was indicated. Surgical exploration confirmed the radiologic findings. Incision of the renal capsula allowed eliminating parenchymal compression without showing active bleeding or other sources of compression. Prompt recovery of diuresis was noted already at the end of the intervention.There were no postoperative complications. The patient was di...

Page phenomenon in a transplanted kidney: is it salvageable?

“…However, most of these cases are due to iatrogenic causes, mainly biopsies, and, less frequently, trauma 4. Surgical decompression has been found to be the intervention of choice and has resolved it successfully in about 80% of the cases reported in the literature 5 15–24. However, even with surgical evacuation, the results could be unfavourable with still a high risk of losing the graft.…”