Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report

Abstract

Introduction: Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys. Clinical case: The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy. Discussion: Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function.Sommario Introduzione: L'uropatia ostruttiva da calcolosi si verifica di rado nel rene trapiantato. Caso clinico: Gli autori riportano il caso di un paziente trapiantato renale mediante ureterostomia, già sottoposto a gastrectomia per carcinoma gastrico, che presenta episodio di insufficienza renale acuta 7 anni dopo l'intervento. L'esame ecografico non mostra segni di rigetto e permette di evidenziare viceversa un'idronefrosi di grado non marcato a carico del rene trapiantato. La successiva TC rivela calcolo del tratto medio dell'uretere a livello dell'incrocio con i vasi iliaci. Il paziente viene pertanto sottoposto, in urgenza, a nefrostomia percutanea del graft con buona ripresa della diuresi e della funzionalità renale. Inviato presso il Centro * Corresponding author. Sezione di Nefrologia Preventiva, Dipartimento di Nefrologia e Dialisi, Ospedale di S.ta Maria Nuova, Via Gadda 30, 42100 Reggio Emilia, Italy.E-mail address: lusenti.tiziano@asmn.re.it (T. Lusenti). Trapianti di competenza viene sottoposto ad intervento di ureterotomia con asportazione del calcolo e successiva uretero-pielotomia. Per ritenzione urinaria di origine prostatica viene inoltre sottoposto a TURP. L'esame istologico mostra carcinoma prostatico stadio 3 sec. Gleason, che si decide di trattare in modo conservativo con radioterapia, con mantenimento della già blanda terapia immunodepressiva. Discussione: La calcolosi viene annoverata tra le cause meno comuni di uropatia ostruttiva del rene trapiantato. Nel caso descritto l'ecografi...

Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis

“…As in general patient populations, kidney stones can also cause acute kidney injury in kidney transplant recipients[49-52]. Since kidney transplant recipients can have obstructed kidney stones without any symptom of pain[26,28], prompt diagnosis and the removal of obstructed stones are the keys to preventing renal allograft failure[18].…”

Management of de novo nephrolithiasis after kidney transplantation: a comprehensive review from the European Renal Association CKD-MBD working group

“…It is thus surprising that evidence is limited linking kidney stones to graft function and survival after kidney transplantation. A small number of case reports have been published illustrating cases of obstructive nephropathy and kidney graft failure due to renal or ureteral calculi [ 69–71 ]. A single-centre retrospective observational study conducted in 574 kidney transplant recipients, with a mean (±standard deviation) follow-up period of 55 ± 53 months and nephrolithiasis prevalence of 4.4%, demonstrated that nephrolithiasis did not have an impact on allograft survival (odds ratio 1.04, CI 0.708–1.54, P = .824) [ 72 ].…”

Renal allograft dysfunction secondary to ureterolithiasis: Diagnosis and management

“…Diagnosis of proximal ureteric calculi can be reliably made on ultrasonography while mid and distal ureteric calculi are more effectively detected using CT or MR urography. 13 Management of calculi in transplanted kidney is similar to the management in patients with solitary functioning kidneys. The minimally invasive techniques are performed first.…”