UROLITHIASIS IN TRANSPLANTED KIDNEY Dr.GOVINDARAJAN, Dr.KRISHNAN, Dr.KARTHIKEYAN, Dr.R.P.RAJAN & Dr.SANKARAN DEPT OF UROLOGY SRMC & RI

HISTORY ANURIA for 2 days presenting 2 years post transplant S.CREAT : 7.4 BUN : 56 S.URIC ACID: 10.3 S.CALCIUM: 9.8

USG done elsewhere revealed 2 CALCULI Lower calyceal calculi (9 mm) Upper Ureteric calculi with proximal HUN of transplanted Kidney X-ray KUB showed no radio opaque shadow HISTORY…

PAST HISTORY TRANSPLANT DONE 2 YEARS AGO FOR ESRD NO CALCULI IN THE DONOR KIDNEY (DONOR WAS SISTER) NO POST OP COMPLICATION AT THAT TIME PATIENT WAS EVALUATED FOR LUTS AND SUBSEQUENTLY UNDERWENT TURP 1 YEAR AGO

INVESTIGATIONS REPEAT USG : Upper ureteric calculi with HUN and lower calyceal calculi measuring 9-10mm S.CREAT : 6.7 S.URIC ACID: 5.6 S.CALCIUM : 9.8 X-RAY KUB : NO ROS

INITIAL MANAGEMENT INITIAL MANAGEMENT WAS IN THE FORM OF USG GUIDED PCN RENAL PARAMETERS STABILIZED TO NORMAL LEVELS IN 3 DAYS NEPHROSTOGRAM WAS DONE AND SHOWED 2 RADIOLUCENT CALCULI

DEFINITE TREATMENT THE PCN TRACT WAS DILATED AND SEMIRIGID URS WAS USED TO FRAGMENT THE LOWER CALYCEAL CALCULI WITH SWISS LITHOCLAST UPPER URETERIC CALCULI COULD NOT BE REACHED WITH URS DUE TO AN ACUTE KINK

DEFINITE MANAGEMENT TREATMENT OF THE URETERIC CALCULI WAS DONE BY ESWL WITH CONTRAST INSTILLATION THROUGH THE PCN TRACT STONE FRAGMENTED WELL AND WAS VOIDED USG DONE TWO WEEKS LATER SHOWED COMPLETE CLEARANCE STENT WAS REMOVED AFTER 4 WEEKS.

REVIEW OF LITERATURE INCIDENCE OF RENAL CALCULI IN TRANSPLANT KIDNEY IS 0.9 TO 3.2 % ETIOLOGY AND INCIDENCE CITED ARE THE SAME AS IN GENERAL POPULATION

PCN AND ANTEGRADE INTERVENTION FLEXIBLE URS AND LASER SEMIRIGID URS AND LASER/LITHOTRIPSY ESWL TREATMENT OPTION

CONCLUSIONS CALCULUS ANURIA IN TRANSPLANT KIDNEY IS AN EMERGENCY SITUATION INITIAL MANAGEMENT OF CALCULUS ANURIA WILL IDEALLY BE PCN SUBSEQUENT MANAGEMENT WILL DEPEND ON THE CLINICAL SITUATION AND SETUP

CONCLUSIONS CLINICAL FEATURES OF ACUTE COLIC ARE NOT CLASSICAL STENTING PARTICULARLY RETROGRADE IS EXPECTED TO BE DIFFICULT