Urolithiasis in renal transplantation: Diagnosis and management

Abstract

Obiectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Patients and Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation in the Kidney Transplant Unit of Treviso General Hospital. Ten (10%) of them developed urinary calculi and were referred at our institution. Their mode of presentation, investigation and treatment were recorded. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasound in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found at removal of the ureteral stent. Nephrostomy tube was placed in 5 patients. Hypercalcemia with hyperparathyroidism (HPT) was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by shock wave lithotripsy (SWL) and one of them was stone-free after two sessions. Two patients, one with multiple pielocaliceal calculi and the other with staghorn calculus in the lower calyx, were treated with percutaneous nephrolitothotomy (PCNL). Three patients were treated by ureteroscopy (URS) and in one of them two treatments were carried out. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of URS. Two patients with calculi discovered at removal of the ureteral stent were treated by URS. Conclusions: The incidence of urolithiasis in renal transplantation is uncommon. In the most of patients the condition occurs without pain. Metabolic anomalies and medical treatment after renal transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with a minimal incidence of risk for the renal allograft.KEY WORDS: Urolithiasis management, Renal transplantation. In the most of cases stone formation appears to form "de novo" after renal transplantation, although some studies suggest that the calculi are more often transplanted with the graft to the recipient (1, 5, 6). Theremore, metabolic anomalies causing stone formation could be present in allograft rather than native kidneys (7). Urolithiasis is often asymptomatic and the clinicians are not able to diagnose urinary calculi in renal transplant at an earlier stage. Neverthless, the prompt diagnosis and the subsequently stone removal is necessary to prevent adverse effects on a solitary kidney whose renal function is often borderline. Today the development of endourological tecniques for calculi management and interventional radiology for the emergency management of acute obstruction have minimized the potential risk for renal graft. However, such minimally invasive procedures could be performed only in centers that are well equipped and have expertise to offer the appropriate treatment. We evaluated our experience of renal transplant patients with urolithiasis, regarding the risk factors associate...

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

“…The remaining 157 articles underwent full-length review, and an additional 136 were excluded for failing to meet the criteria. Twenty one articles[12-29,36,38,40] met all inclusion criteria and were identified for the meta-analysis of kidney stones in kidney transplant recipients (Table 1). Supplementary Item 2 outlines our search methodology and selection process.…”

“…After successful kidney transplantation, ESRD patients subsequently have significant improvement in renal function resulting in urinary excretion of metabolites that increases risk of stone disease. Studies have identified kidney stones in allograft kidney as one of the serious problems in kidney transplant recipients[12-40]. However, unlike the general population, the incidence and characteristics of kidney stones in kidney transplant recipients are not well studied.…”

Böbrek nakli sonrası üriner sistem taşı ve konservatif tedavisi

“…Genel olarak asemptomatik nakil böbrekteki 4 mm altındaki kalküller güvenle izlenebilir, bu taşlar spontan düşme eğilimindedir 12,13 . Literatürde böbrek nakli sonrası üriner sistem taşı ve obstrüksiyon nedeniyle nefrostomi kateteri takılan ve ESWL, URS ve PCNL gibi tedavi yöntemlerinin uygulandığı hastalar bildirilmiştir 10,14,15 . Geniş serilerde %80 üzeride başarı ile etkili ve güvenli şekilde uygulanabilen bir yöntem olan ESWL tedavisi böbrek nakli öncesi veya nakil sonrası taşlı allogrefte uygulanabilir.…”

Tubeless percutaneous nephrolithotomy (pcnl) in renal allografts: a case report and mini-review

“…2 And also, the proximity to the bony pelvis causes that targeting the shock wave directly onto the stone becomes more difficult in ESWL. 1,4,9,10,22 But the anatomic position in the iliac fossa with the renal surface close to skin makes PCNL an attractive alternative and a feasible procedure in the treatment of urinary calculi. 10 Many cases have been reported in which allograft lithiass was treated successfully with PCNL.…”

“…[1][2][3][4] Among them urinary stone is a rare complication and its prevalence reported between 0.2% and 6.3%. 1,2,[5][6][7][8] Urinary calculi are often asymptomatic so it is difficult to diagnose them at an early stage by physicians 1 and they are usually diagnosed when a sudden worsening kidney function happens or pyelonephritis is detected. 2 The best and most accurate method to detect the size and location of the stone is ultrasound.…”