1
|
Solano C, Corrales M, Panthier F, Doizi S, Traxer O. Comprehensive Approaches to Urolithiasis in Renal Transplants: A Narrative Review. J Clin Med 2024; 13:4268. [PMID: 39064308 PMCID: PMC11278228 DOI: 10.3390/jcm13144268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
This review addresses the management of urolithiasis in renal transplant recipients, a notably vulnerable group due to the unique anatomical and physiological alterations of the transplanted organ. The prevalence of nephrolithiasis in these patients varies between 0.1% and 6.3%, with a significant impact on graft longevity and function. Surgical access complications due to the renal graft's position on the iliac vessels and the variety of urinary anastomoses complicate the treatment approaches. This study evaluates the effectiveness and outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), two primary minimally invasive strategies for managing graft stones. Through a narrative review using the PubMed and EMBASE databases, it was found that PCNL offers high stone-free rates especially beneficial for large stones, whereas URS provides a less invasive option with a lower risk of complications for small stones. Both techniques require tailored approaches based on stone composition-mostly calcium oxalate-and specific patient anatomical factors. This review underscores the importance of early diagnosis, appropriate treatment selection, and continuous post-treatment monitoring to mitigate risks and promote long-term renal function in transplant recipients.
Collapse
Affiliation(s)
- Catalina Solano
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
- Uroclin S.A.S., Department of Endourology, Medellín 050021, Colombia
| | - Mariela Corrales
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| | - Frédéric Panthier
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| | - Steeve Doizi
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| | - Olivier Traxer
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| |
Collapse
|
2
|
Lo CYZ, Chong D, Sjariffudin IF, Chong TW, Lu Y. Percutaneous nephrolithotomy for adult renal transplant de novo graft lithiasis: a single center analysis and systematic review of the literature. World J Urol 2024; 42:373. [PMID: 38869666 DOI: 10.1007/s00345-024-05079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION/OBJECTIVE Graft stones in renal transplant recipients pose a unique challenge, finding effective interventions to ensure optimal graft function and patient well-being. Various methods of stone clearance have been described for graft stones, including percutaneous nephrolithotomy (PCNL). While PCNL is a promising approach for managing graft stones, specific outcomes and associated characteristics for this approach have not been comprehensively evaluated before. This study aims to evaluate the safety and efficacy of the use of PCNL as the primary intervention of graft stones by assessing stone-free rates (SFR), treatment impact on graft function, and perioperative complications. METHODS A retrospective clinical audit was performed for all transplants performed in a single center from 2007 to 2022, which included all graft lithiasis patients who were treated with PCNL. Both perioperative parameters and post-operative outcomes were collected. In addition, a systematic review including articles from MEDLINE, Embase, Web of Science yielded 18 full-text articles published between 1/1/2000 and 15/11/2023. The results pertaining to patients who underwent PCNLs for graft stones were cross-referenced and thoroughly evaluated. The review encompassed a comprehensive analysis of clinical data, postoperative outcomes, and procedural details. The protocol for the systematic review was prospectively registered on PROSPERO (CRD42023486825). RESULTS In our center, 6 graft lithiasis patients were treated with PCNL. The initial SFR was 83.3%. SFR at 3 months and 1 year were both 100.0%. SFR at 3 years was 66.7%. Other centers reported initial SFR of 82.6-100.0% (interquartile range). SFR at 3 months, 1 year, 3 years was not well reported across the included studies. Incidence of graft lithiasis ranged from 0.44%-2.41%. Most common presentations at diagnosis were oliguria/anuria/acute kidney injury and asymptomatic. Reported complications included blood loss, transient hematuria, high urine output, sepsis, and damage to surrounding structures. The most commonly reported metabolic abnormalities in transplant lithiasis patients included hyperuricemia and hyperparathyroidism. CONCLUSION PCNL is a practical and efficient choice for addressing graft lithiasis, demonstrating excellent stone clearance and minimal perioperative complications. These findings show the importance of PCNL as a primary intervention in this complex patient population.
Collapse
Affiliation(s)
| | - Dominic Chong
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.
| | | | - Tsung Wen Chong
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yadong Lu
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
3
|
Kanbay M, Copur S, Bakir CN, Hatipoglu A, Sinha S, Haarhaus M. Management of de novo nephrolithiasis after kidney transplantation: a comprehensive review from the European Renal Association CKD-MBD working group. Clin Kidney J 2024; 17:sfae023. [PMID: 38410685 PMCID: PMC10896178 DOI: 10.1093/ckj/sfae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Indexed: 02/28/2024] Open
Abstract
The lifetime incidence of kidney stones is 6%-12% in the general population. Nephrolithiasis is a known cause of acute and chronic kidney injury, mediated via obstructive uropathy or crystal-induced nephropathy, and several modifiable and non-modifiable genetic and lifestyle causes have been described. Evidence for epidemiology and management of nephrolithiasis after kidney transplantation is limited by a low number of publications, small study sizes and short observational periods. Denervation of the kidney and ureter graft greatly reduces symptomatology of kidney stones in transplant recipients, which may contribute to a considerable underdiagnosis. Thus, reported prevalence rates of 1%-2% after kidney transplantation and the lack of adverse effects on allograft function and survival should be interpreted with caution. In this narrative review we summarize current state-of-the-art knowledge regarding epidemiology, clinical presentation, diagnosis, prevention and therapy of nephrolithiasis after kidney transplantation, including management of asymptomatic stone disease in kidney donors. Our aim is to strengthen clinical nephrologists who treat kidney transplant recipients in informed decision-making regarding management of kidney stones. Available evidence, supporting both surgical and medical treatment and prevention of kidney stones, is presented and critically discussed. The specific anatomy of the transplanted kidney and urinary tract requires deviation from established interventional approaches for nephrolithiasis in native kidneys. Also, pharmacological and lifestyle changes may need adaptation to the specific situation of kidney transplant recipients. Finally, we point out current knowledge gaps and the need for additional evidence from future studies.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Cicek N Bakir
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alper Hatipoglu
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Smeeta Sinha
- Department of Renal Medicine, Salford Royal NHS Institute, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Mathias Haarhaus
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Piana A, Basile G, Masih S, Bignante G, Uleri A, Gallioli A, Prudhomme T, Boissier R, Pecoraro A, Campi R, Di Dio M, Alba S, Breda A, Territo A. Kidney stones in renal transplant recipients: A systematic review. Actas Urol Esp 2024; 48:79-104. [PMID: 37574010 DOI: 10.1016/j.acuroe.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. EVIDENCE ACQUISITION A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. EVIDENCE SYNTHESIS A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. CONCLUSIONS Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.
Collapse
Affiliation(s)
- A Piana
- Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy; Departamento de Urología, Universidad de Turín, Turín, Italy.
| | - G Basile
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - S Masih
- Servicio de Urología, Centro Médico de la Universidad de Toledo, Toledo, OH, United States
| | - G Bignante
- Departamento de Urología, Universidad de Turín, Turín, Italy
| | - A Uleri
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - A Gallioli
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - T Prudhomme
- Servicio de Urología, Trasplante Renal y Andrología, Hospital Universitario de Rangueil, Toulouse, France
| | - R Boissier
- Servicio de Urología y Trasplante Renal, Hospital Universitario La Concepción, Marsella, France
| | - A Pecoraro
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
| | - R Campi
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
| | - M Di Dio
- Sección de Urología, Servicio de Cirugía, Hospital Annunziata, Cosenza, Italy
| | - S Alba
- Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy
| | - A Breda
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - A Territo
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
5
|
de Arruda PFF, de Arruda LF, Rizzo RHD, de Arruda LF. Lithiasis in transplant kidney: what to do? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230791. [PMID: 37820168 PMCID: PMC10561906 DOI: 10.1590/1806-9282.20230791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/22/2023] [Indexed: 10/13/2023]
Affiliation(s)
| | | | | | - Lara Ferraz de Arruda
- São José do Rio Preto School of Medicine, Postgraduate Program in Health Sciences – São José do Rio Preto (SP), Brazil
| |
Collapse
|
6
|
Boissier R, Rodriguez-Faba O, Zakri RH, Hevia V, Budde K, Figueiredo A, García EL, Olsburgh J, Regele H, Yuan CY, Breda A. Evaluation of the Effectiveness of Interventions on Nephrolithiasis in Transplanted Kidney. Eur Urol Focus 2022:S2405-4569(22)00278-4. [PMID: 36567234 DOI: 10.1016/j.euf.2022.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
CONTEXT De Novo nephrolithiasis in renal transplant can have severe consequences since renal transplantation involves a single functioning kidney with medical and anatomical specificities (heterotopic transplantation on iliac vessels, immunosuppressive treatments, and comorbidities). OBJECTIVE To systematically review all available evidence on the prevalence of de novo nephrolithiasis in renal transplant, presentation, and stone characteristics, and to report in a meta-analysis the efficacy of stone treatments (extracorporeal shock wave lithotripsy [ESWL], medical treatment, percutaneous nephrolithotomy [PCNL], open surgery, and ureteroscopy). EVIDENCE ACQUISITION Medline, Embase, and the Cochrane Library were searched up to November 2021 for all relevant publications reporting the management of de novo nephrolithiasis in renal allografts. The primary outcome was stone-free rate (SFR) at 3 mo. Secondary outcomes included prevalence, stone characteristics (size, density, and composition), symptoms on presentation, need for drainage, complications, and recurrence. Data were narratively synthesized in light of methodological and clinical heterogeneity, and a meta-analysis was performed for SFR. The risk of bias of each included study was assessed. EVIDENCE SYNTHESIS We included 37 retrospective studies with 553 patients and 612 procedures; of the 612 procedures 20 were antegrade ureteroscopy, 154 retrograde ureteroscopy, 118 PCNL, 25 open surgery, 155 ESWL, and 140 surveillance/medical treatment. The prevalence of nephrolithiasis in renal transplant was 1.0%. The mean stone size on diagnosis was 11 mm (2-50). The overall SFR at 3 mo was 82%: 96% with open surgery, 95% with antegrade ureteroscopy, 86% with PCNL, 81% with retrograde ureteroscopy, and 75% with ESWL. CONCLUSIONS De novo nephrolithiasis in renal transplant is an infrequent condition. A high SFR were obtained with an antegrade approach (ureteroscopy, PCNL, and open approach) that should be considered in renal transplant patients owing to the heterotopic position of the renal graft. The choice of technique was correlated with stone size: generally ureteroscopy and ESWL for stones 11-12 mm (mean stone size) versus PCNL and open surgery for 17-25 mm stones. PATIENT SUMMARY De novo nephrolithiasis in renal transplants is an infrequent situation that can have severe consequences on the function of the renal graft. We evaluated the efficacy of each treatment and noted that antegrade approaches (open surgery, percutaneous nephrolithotomy, and antegrade ureteroscopy) were associated with the highest stone-free rate. As opposed to the management of nephrolithiasis in native kidney, an antegrade approach should be considered more in renal transplant patients.
Collapse
Affiliation(s)
- Romain Boissier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, France
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Rhana Hassan Zakri
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
| | - Enrique Lledó García
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jonathon Olsburgh
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Cathy Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain.
| |
Collapse
|
7
|
[A CASE REPORT OF VESICAL CALCULUS FORMATION WITH CHROMIC CATGUT AT THE URETEROVESICAL ANASTOMOTIC SITE 28 YEARS AFTER RENAL TRANSPLANTATION]. Nihon Hinyokika Gakkai Zasshi 2022; 112:49-52. [PMID: 35046237 DOI: 10.5980/jpnjurol.112.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 69-year-old man underwent renal transplantation due to chronic renal failure of unknown cause in 1991. Furthermore, in 2012 he again underwent renal transplantation due to renal graft dysfunction with focal segmental glomerulosclerosis. After the second renal transplantation, his renal function has been stable. In 2019, he presented to the urology department with gross hematuria. Cystoscopy revealed a 2 cm vesical calculus at the dome of the bladder near the right lateral wall. Therefore, we performed transurethral lithotripsy using the holumium laser method. The vesical calculus was crushed, revealing a suture at the center, suggesting the suture as the cause. We tried to remove the suture during operation, however, it was impossible. Although the remaining suture posed a risk for calculus development, there has been no recurrence of a calculus for 6 months after the operation. This case reports a vesical calculus at the ureterovesical anastomotic site, wherein the core was an absorbable suture used during the initial renal transplantation. It should be taken into consideration that there is a possibility of anastomotic calculus occurrence with absorbable sutures, even long after renal transplantation.
Collapse
|
8
|
Bolen E, Stern K, Humphreys M, Brady A, Leavitt T, Zhang N, Keddis M. Urine metabolic risk factors and outcomes of patients with kidney transplant nephrolithiasis. Clin Kidney J 2021; 15:500-506. [PMID: 35211306 PMCID: PMC8862062 DOI: 10.1093/ckj/sfab208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
Nephrolithiasis in allograft kidneys is rare, but this diagnosis may lead to allograft complications and patient morbidity. Previous studies that have evaluated nephrolithiasis posttransplant have focused on surgical stone management, with limited data on urine metabolic risk factors and the presence of stones after follow-up.
Methods
We retrospectively evaluated kidney transplant recipients who were diagnosed with transplant nephrolithiasis between 2009 and 2019. Computed tomography and ultrasound imaging were used to confirm stone presence.
Results
The incidence of allograft kidney stone formation was 0.86% of 6548 kidney transplant recipients. Of the 56 cases identified, 17 (30%) had a pretransplant history of nephrolithiasis. Only four (7%) patients received a known kidney stone at the time of allograft implantation. Of the 56 cases, 34 had a 24-h supersaturation study. The urine supersaturation study showed 32 patients (94%) had a urine citrate of <450 mg excreted in 24 h (median 124.5 mg/24 h, reference range >500 mg/24 h), along with 22 patients (61%) having a urine oxalate excretion of ≥30 mg in 24 h (median 34.4 mg/24 h, reference range <30 mg/24 h). Calcium oxalate composition was most common (91% with >1 supersaturation for calcium oxalate crystals), with normal median urine calcium levels (median urine calcium 103.5 mg/24 h, reference range <200 mg/24 h). After a 4-year follow-up, 50% (n = 28) required surgical intervention and 43 (77%) patients continued to have evidence of transplant nephrolithiasis on imaging.
Conclusions
This is the largest study of transplant nephrolithiasis confirming that hypocitraturia and hyperoxaluria were the most significant urine metabolic risk factors associated with allograft nephrolithiasis and that hyperoxaluria was the most prevalent driver for calcium oxalate stone composition. Our study is first to show low stone-free rates at the last follow-up and a significant proportion requiring surgical intervention.
Collapse
Affiliation(s)
- Erin Bolen
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Karen Stern
- Department of Urology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
| | - Mitchell Humphreys
- Department of Urology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
| | - Alexandra Brady
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA
| | - Todd Leavitt
- Department of Statistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Nan Zhang
- Department of Statistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Mira Keddis
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
9
|
Deininger S, Nadalin S, Amend B, Guthoff M, Heyne N, Königsrainer A, Strohäker J, Stenzl A, Rausch S. Minimal-invasive management of urological complications after kidney transplantation. Int Urol Nephrol 2021; 53:1267-1277. [PMID: 33655463 PMCID: PMC8192401 DOI: 10.1007/s11255-021-02825-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Kidney transplantation represents the gold standard treatment option for patients with end-stage renal disease. Improvements in surgical technique and pharmacologic treatment have continuously prolonged allograft survival in recent years. However, urological complications are frequently observed, leading to both postoperative morbidity and putative deterioration of allograft function. While open redo surgery in these patients is often accompanied by elevated surgical risk, endoscopic management of urological complications is an alternative, minimal-invasive option. In the present article, we reviewed the literature on relevant urological postoperative complications after kidney transplantation and describe preventive approaches during the pre-transplantation assessment and their management using minimal-invasive approaches.
Collapse
Affiliation(s)
- Susanne Deininger
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jens Strohäker
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| |
Collapse
|
10
|
Chaker H, Yaich S, Fendri B, Toumi S, Kammoun K, Mseddi MA, Hadj Slimen M, Ben Hmida M. [Urolithiasis of the kidney transplanted patient in south Tunisia: A 17-year experience]. Nephrol Ther 2020; 16:414-419. [PMID: 33203612 DOI: 10.1016/j.nephro.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Urolithiasis in a kidney transplanted patient is an uncommon but complex urological complication. Its potential severity comes from its occurrence on a solitary kidney and on a field of immunosuppression. The aim of our study is to assess the incidence, characteristics and course of urolithiasis in our series. METHODS A retrospective study was performed. We included kidney transplanted patients between November 2002 and November 2019 and presenting lithiasis during their follow-up. Clinical, biological and radiological data were collected as well as lithiasis disease related data. The management of and patient's evolution were also specified. RESULTS Seven of 416 kidney transplanted patients developed lithiasis during their follow-up with an incidence of 1.6 %. The mean age at lithiasis diagnosis was 36.5 years [24-55 years], the sex ratio was 1.3. They developed stones after mean follow-up of 67 months [4-168 months]. The stones' size varied from 2 to 18mm. Treatment was alkalisation in 3 cases, extracorporeal lithotripsy in 2 cases, a double J stent in 3 cases and pyelolithotomy in 2 cases. Four patients had multiple treatments. Three patients had 1 residual stone during evolution (7mm average diameter), 1 microlithiasis, 1 lost to follow-up after treatment and only 2 (out of 7) were "stone free". Furthermore, lithiasis didn't damage the graft survival after a median follow-up of 62 months post-treatment. CONCLUSION Urolithiasis in the kidney transplanted patient requires an adapted multidisciplinary management. Its skill is a challenge for both the nephrologist and urologist.
Collapse
Affiliation(s)
- Hanen Chaker
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie.
| | - Soumaya Yaich
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | - Beya Fendri
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | - Salma Toumi
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | - Khawla Kammoun
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | | | | | - Mohamed Ben Hmida
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| |
Collapse
|
11
|
Li X, Li B, Meng Y, Yang L, Wu G, Jing H, Bi J, Zhang J. Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature. BMC Nephrol 2020; 21:238. [PMID: 32576135 PMCID: PMC7310338 DOI: 10.1186/s12882-020-01896-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a challenging situation. METHODS We retrospectively analyzed the medical history of one patient who suffered renal transplant lithiasis twice, reviewed the relevant literature, and summarized the characteristics of this disease. RESULTS We retrieved 29 relevant studies with an incidence of 0.34 to 3.26% for renal transplant lithiasis. The summarized incidence was 0.52%, and the recurrence rate was 0.082%. The mean interval after transplantation was 33.43 ± 56.70 mo. Most of the patients (28.90%) were asymptomatic. The management included percutaneous nephrolithotripsy (PCNL, 22.10%), ureteroscope (URS, 22.65%), extracorporeal shockwave lithotripsy (ESWL, 18.60%) and conservative treatment (17.13%). In our case, the patient suffered from renal transplant lithiasis at 6 years posttransplantation, and the lithiasis recurred 16 months later. He presented oliguria, infection or acute renal failure (ARF) during the two attacks but without pain. PCNL along with URS and holmium laser lithotripsy were performed. The patient recovered well after surgery, except for a 3 mm residual stone in the calyx after the second surgery. He had normal renal function without any symptoms and was discharged with oral anticalculus drugs and strict follow-up at the clinic. Fortunately, the calculus passed spontaneously about 1 month later. CONCLUSIONS Due to the lack of specific symptoms in the early stage, patients with renal transplant lithiasis may have delayed diagnosis and present ARF. Minimally invasive treatment is optimal, and the combined usage of two or more procedures is beneficial for patients. After surgery, taking anticalculus drugs, correcting metabolic disorders and avoiding UIT are key measures to prevent the recurrence of lithiasis.
Collapse
Affiliation(s)
- Xiaohang Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Baifeng Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yiman Meng
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Lei Yang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Gang Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Hongwei Jing
- Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jianbin Bi
- Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jialin Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
| |
Collapse
|
12
|
Gatz JD, Spangler R. Evaluation of the Renal Transplant Recipient in the Emergency Department. Emerg Med Clin North Am 2019; 37:679-705. [PMID: 31563202 DOI: 10.1016/j.emc.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal transplants are becoming more and more frequent in the United States and worldwide. Studies demonstrate that these patients inevitably end up visiting an emergency department. In addition to typical medical and surgical problems encountered in the general population, this group of patients has unique problems arising from their immunocompromised state and also due to side effects of the medications required. This article discusses these risks and management decisions that the emergency department physician should be aware of in order to prevent adverse outcomes for the patient and transplanted kidney.
Collapse
Affiliation(s)
- John David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA
| | - Ryan Spangler
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
| |
Collapse
|
13
|
A case of allograft ureteral stone successfully treated with antegrade ureteroscopic lithotripsy: use of a 3D-printed model to determine the ideal approach. Urolithiasis 2019; 47:467-471. [PMID: 31399789 DOI: 10.1007/s00240-019-01153-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/03/2019] [Indexed: 01/12/2023]
Abstract
We present the case of a 46-year-old man who underwent successful antegrade ureteroscopy for lithiasis in his allograft ureter. At a scheduled follow-up 15 years after transplantation, computed tomography (CT) detected a 12-mm renal stone in the renal pelvis of the transplanted kidney. During his follow-up, gross hematuria was seen; the stone moved to the ureter, causing hydronephrosis. Ultrasound and non-contrast CT revealed hydronephrosis and a 15-mm stone in the transplanted ureter. Considering the stone size, location, and the difficulty of the access to the anastomosed ureteral orifice, percutaneous ureteroscopic approach was planned. Due to the anatomical difficulty regarding his allograft kidney, we planned to prepare a 3D image and model for selecting the best percutaneous approach. The procedure was performed and a stone-free status was acquired without complication. Under precise simulation, we performed successful antegrade ureteroscopy for lithiasis in the allograft ureter supported by 3D imaging. Use of a 3D printed model may aid in a safe and effective procedure for lithiasis in the allograft kidney and ureter.
Collapse
|
14
|
Abstract
Urologic complications of renal transplant occur commonly and can have significant impact on graft function, survival, and patient morbidity. This review examines the prevalence of urologic complications, risk factors, diagnosis and options for management of the most common urologic complications.
Collapse
Affiliation(s)
- Hannah R Choate
- Presbyterian Transplant Services, Presbyterian HealthCare Services, Albuquerque, NM, USA
| | - Laura A Mihalko
- Division of Urology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Bevan T Choate
- Department of Urology, Raymond G. Murphy VA Health Medical Center, Albuquerque, NM, USA
| |
Collapse
|
15
|
Abstract
RATIONALE Urinary lithiasis is one of severe postoperative complications in patients undergoing renal transplantation, possibly leading to anuria, urinary infection, or even acute renal failure. Potassium sodium hydrogen citrate (PSHC), a potassium-bearing citrate, is commonly prescribed to prevent stone formation. PATIENT CONCERNS A 25-year-old man (patient 1) and a 31-year-old man (patient 2) receiving renal transplantation for end-stage renal disease (ESRD) were enrolled in this study. They were given 10 g/day of PSHC granules from the ninth day to the 17th day after surgery. Patient 1 presented chest tightness, nausea, muscle weakness, and ascending paralysis on the 10th day. Patient 2 presented weak waves on EGG on the 17th day. Moreover, their serum potassium concentrations (SPCs) were 7.67 and 6.05 mmol/L, respectively. DIAGNOSIS Acute hyperkalemia. INTERVENTIONS Hemo-filtration was performed for patient 1, while patient 2 received 10% calcium gluconate 10 mL, 5% NaHCO3 125 mL, and 10% glucose 500 mL with the addition of 10 units of insulin through intravenous drip. OUTCOMES Their SPCs dropped to the normal range. LESSONS Physicians should pay close attentions to potential risks caused by PSHC, and monitor the SPCs to minimize the occurrence of hyperkalemia.
Collapse
|
16
|
Moris D, Bokos J, Vailas M, Kakavia K, Spartalis E, Athanasiou A, Schizas D, Vernadakis S. Renal paratransplant hernia revealed: a review of the literature. Hernia 2017; 21:363-367. [PMID: 27866294 DOI: 10.1007/s10029-016-1551-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Renal paratransplant hernia (RPH) is an uncommon variant of internal hernias developed in renal transplant recipients. The aim of this review is to meticulously present and analyze all data coming mainly from case reports or short-case studies on this very uncommon surgical entity. MATERIALS AND METHODS The MEDLINE/PubMed database was searched for publications with the medical subject heading ''renal paratransplant hernia''. All the references from the identified articles were searched for relevant information. The end date of the literature search was set to March 2016. RESULTS Our search revealed five publications, three short clinical series (three cases each) and two case reports. The total number of cases retrieved was 11. RPH should be considered as an iatrogenic surgical complication. The incidence is around 0.45%. CONCLUSIONS RPH is a relatively uncommon but potentially fatal complication after renal transplantation, and its non-specific symptoms may lead to misdiagnosis. Physician awareness, prompt diagnosis, and early surgical intervention are critical. In addition, meticulous surgical technique during transplantation may help avoid this complication.
Collapse
Affiliation(s)
- D Moris
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece.
| | - J Bokos
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| | - M Vailas
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| | - K Kakavia
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| | - E Spartalis
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| | - A Athanasiou
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| | - D Schizas
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| | - S Vernadakis
- Transplantation Unit, Laikon General Hospital, Agiou Thoma 17 Street, Athens, Greece
| |
Collapse
|
17
|
Argyrou C, Moris D, Vernadakis S. Steering between Scylla and Charybdis: Picking out the optimum time of double-J stent removal following renal transplantation. Transplant Rev (Orlando) 2017; 31:96-99. [PMID: 27884503 DOI: 10.1016/j.trre.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Demetrios Moris
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | |
Collapse
|
18
|
Cheungpasitporn W, Thongprayoon C, Mao MA, Kittanamongkolchai W, Jaffer Sathick IJ, Dhondup T, Erickson SB. Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis. World J Transplant 2016; 6:790-797. [PMID: 28058231 PMCID: PMC5175239 DOI: 10.5500/wjt.v6.i4.790] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/08/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the incidence and characteristics of kidney stones in kidney transplant recipients.
METHODS A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the inception of the databases through March 2016. Studies assessing the incidence of kidney stones in kidney transplant recipients were included. We applied a random-effects model to estimate the incidence of kidney stones.
RESULTS Twenty one studies with 64416 kidney transplant patients were included in the analyses to assess the incidence of kidney stones after kidney transplantation. The estimated incidence of kidney stones was 1.0% (95%CI: 0.6%-1.4%). The mean duration to diagnosis of kidney stones after kidney transplantation was 28 ± 22 mo. The mean age of patients with kidney stones was 42 ± 7 years. Within reported studies, approximately 50% of kidney transplant recipients with kidney stones were males. 67% of kidney stones were calcium-based stones (30% mixed CaOx/CaP, 27%CaOx and 10%CaP), followed by struvite stones (20%) and uric acid stones (13%).
CONCLUSION The estimated incidence of kidney stones in patients after kidney transplantation is 1.0%. Although calcium based stones are the most common kidney stones after transplantation, struvite stones (also known as “infection stones”) are not uncommon in kidney transplant recipients. These findings may impact the prevention and clinical management of kidney stones after kidney transplantation.
Collapse
|
19
|
Harraz AM, Kamal AI, Shokeir AA. Urolithiasis in renal transplant donors and recipients: An update. Int J Surg 2016; 36:693-697. [DOI: 10.1016/j.ijsu.2016.11.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
|
20
|
Krajewski W, Dembowski J, Kołodziej A, Małkiewicz B, Tupikowski K, Matuszewski M, Chudoba P, Boratyńska M, Klinger M, Zdrojowy R. Urological complications after renal transplantation - a single centre experience. Cent European J Urol 2016; 69:306-311. [PMID: 27730001 PMCID: PMC5057052 DOI: 10.5173/ceju.2016.833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/26/2016] [Accepted: 06/13/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Urological complications after renal transplantation occur in between 2.5% and 30% of all graft recipients. The aim of the study was to present 7 years of experience in urological treatment of patients with a transplanted kidney. We aimed to identify retrospectively late urological complications in renal transplant recipients at a single center and analyze the treatment modalities and their outcome. Material and methods Between January 2008 and December 2014, a total of 58 patients after KTX were treated in the Department of Urology because of post-transplant urological complications that occurred during follow-up at the Transplant Outpatient Department. Retrieved data were analysed in retrospectively. Results In the group of 38 patients with ureteral stenosis (Clavien grade III), 29 patients underwent endoscopy, 8 open surgical procedures and one both endoscopic and open operation. Ten patients were admitted with symptomatic lymphocoele (Clavien III), of which 9 were successfully treated with drainage and one with surgical marsupialization. Because of urolithiasis in the grafted kidney (Clavien grade III), 4 patients were treated with ureterorenoscopic lithotripsy (URSL) and one only with the extracorporeal shock wave lithotripsy (ESWL) procedure. Five urethral strictures plasties and one graftectomy because of purulent pyelonephritis were also conducted. The average age in the group of recipients who experienced urologic complications was similar (46.1 vs. 47.8) to those without complications. There was no vesicoureteral reflux or ureteral necrosis requiring surgical intervention, no graft loss and death related to urological complication and treatment. Conclusions Most complications could be successfully treated with endourological procedures. The kidney function improved in the majority of patients.
Collapse
Affiliation(s)
- Wojciech Krajewski
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Tupikowski
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Michał Matuszewski
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Paweł Chudoba
- Department of Vascular, General and Transplant Surgery, Wrocław Medical University, Wrocław, Poland
| | - Maria Boratyńska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Urology and Oncological Urology Department, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
21
|
Urological Consequences following Renal Transplantation: A Review of the Literature. Urologia 2015; 82:211-8. [DOI: 10.5301/uro.5000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 01/25/2023]
Abstract
Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies. The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.
Collapse
|