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Li X. et al., 2020: Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature

Li X, Li B, Meng Y, Yang L, Wu G, Jing H, Bi J, Zhang J.
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.
Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China.
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.

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.
BMC Nephrol. 2020 Jun 23;21(1):238. doi: 10.1186/s12882-020-01896-5. PMID: 32576135. FREE ARTICLE

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Comments 1

Peter Alken on Monday, August 17 2020 08:35

This is for the urologist among the readers: How many mistakes or misjudgments do you find?
“A 35-year-old male with end-stage renal disease of unknown cause underwent cadaveric renal transplantation in our department 6 years ago. … the patient suddenly fevered with a temperature of 38.8 °C and shiver, accompanied by oliguria …
Computerized tomography (CT) showed that there was a stone with a size of 18mm in the ureteropelvic junction, which caused mild hydronephrosis …
We could not insert the guide wire into the new orifice with a 70° lens ureteroscope, although we switched to a semirigid ureteroscope. Therefore, we had to perform percutaneous nephrolithotripsy (PCNL) to remove the stones …”

… We did not analyze the stone composition after the first operation.

… admitted to the hospital again 16 months after the operation for similar symptoms, including fever (39 °C), shivers, and anuria, …CT demonstrated a 12mm calculus in the proximal ureter with severe extension of the ureter and hydronephrosis
… percutaneous nephrostomy tube was first placed emergentlv, …After the improvement of allograft function, PCNL was performed …Analysis of stone composition indicated a uric acid calculus, so potassium sodium hydrogen citrate (2.5 g, 3 times a day) was administered.

… Based on the constituent of his calculus after the second operation, we deduced that the level of uric acid in the urine may have been higher, although it was normal in the blood. Unfortunately, we did not detect uric acid in urine …”

5-7 is the right number

Peter Alken

This is for the urologist among the readers: How many mistakes or misjudgments do you find? “A 35-year-old male with end-stage renal disease of unknown cause underwent cadaveric renal transplantation in our department 6 years ago. … the patient suddenly fevered with a temperature of 38.8 °C and shiver, accompanied by oliguria … Computerized tomography (CT) showed that there was a stone with a size of 18mm in the ureteropelvic junction, which caused mild hydronephrosis … We could not insert the guide wire into the new orifice with a 70° lens ureteroscope, although we switched to a semirigid ureteroscope. Therefore, we had to perform percutaneous nephrolithotripsy (PCNL) to remove the stones …” … We did not analyze the stone composition after the first operation. … admitted to the hospital again 16 months after the operation for similar symptoms, including fever (39 °C), shivers, and anuria, …CT demonstrated a 12mm calculus in the proximal ureter with severe extension of the ureter and hydronephrosis … percutaneous nephrostomy tube was first placed emergentlv, …After the improvement of allograft function, PCNL was performed …Analysis of stone composition indicated a uric acid calculus, so potassium sodium hydrogen citrate (2.5 g, 3 times a day) was administered. … Based on the constituent of his calculus after the second operation, we deduced that the level of uric acid in the urine may have been higher, although it was normal in the blood. Unfortunately, we did not detect uric acid in urine …” 5-7 is the right number Peter Alken
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Tuesday, October 20 2020

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