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Long-neglected stent in a transplanted kidney
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ne p hro l o g y i ma g e
© 2007 International Society of Nephrology Kidney International (2007) 71, 5. doi:10.1038/sj.ki.5001814
Long-neglected stent in a transplanted kidney M Lam1 1MetroHealth Medical Center, Cleveland, Ohio, USA
Correspondence: Nephrology Division, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
Figure 1 | Ultrasonic examination revealed hydronephrosis of the transplanted kidney, with an acoustically shadowing mass (arrow) in the renal pelvis.
Figure 2 | Abdominal film demonstrated calcification at both coiled ends of the stent, and a broken fragment (arrow) from the previous stent.
An 18-year-old woman underwent renal transplantation for reflux nephropathy. Shortly thereafter, she developed ureteral kinking, and a double-J stent was placed in the transplant ureter. The stent was changed only once, 6 months after placement. The patient discontinued her immunosuppressive medications 9 years after transplantation. Fifteen years after transplantation, she presented with a urinary tract infection, localized suprapubic pain, and a serum creatinine of 2.6 mg per dl (230 µmol per liter). Ultrasonic examination revealed hydronephrosis of the transplanted kidney, with an acoustically shadowing mass
(Figure 1, arrow) in the renal pelvis and another in the bladder. Plain film demonstrated calcification at both coiled ends of the stent, and a broken fragment (Figure 2, arrow) from the previous stent. Ultrasonic and laser lithotripsy were employed to fragment the calcified masses, using both percutaneous and cystoscopic approaches. The fragments were extracted, the lower end of the stent was uncoiled, and the stent was carefully extracted through the urethra. The patient’s renal function did not improve, and her renal dysfunction was attributed to chronic allograft nephropathy.
Kidney International (2007) 71
5
ne p hro l o g y i ma g e
© 2007 International Society of Nephrology Kidney International (2007) 71, 5. doi:10.1038/sj.ki.5001814
Long-neglected stent in a transplanted kidney M Lam1 1MetroHealth Medical Center, Cleveland, Ohio, USA
Correspondence: Nephrology Division, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
Figure 1 | Ultrasonic examination revealed hydronephrosis of the transplanted kidney, with an acoustically shadowing mass (arrow) in the renal pelvis.
Figure 2 | Abdominal film demonstrated calcification at both coiled ends of the stent, and a broken fragment (arrow) from the previous stent.
An 18-year-old woman underwent renal transplantation for reflux nephropathy. Shortly thereafter, she developed ureteral kinking, and a double-J stent was placed in the transplant ureter. The stent was changed only once, 6 months after placement. The patient discontinued her immunosuppressive medications 9 years after transplantation. Fifteen years after transplantation, she presented with a urinary tract infection, localized suprapubic pain, and a serum creatinine of 2.6 mg per dl (230 µmol per liter). Ultrasonic examination revealed hydronephrosis of the transplanted kidney, with an acoustically shadowing mass
(Figure 1, arrow) in the renal pelvis and another in the bladder. Plain film demonstrated calcification at both coiled ends of the stent, and a broken fragment (Figure 2, arrow) from the previous stent. Ultrasonic and laser lithotripsy were employed to fragment the calcified masses, using both percutaneous and cystoscopic approaches. The fragments were extracted, the lower end of the stent was uncoiled, and the stent was carefully extracted through the urethra. The patient’s renal function did not improve, and her renal dysfunction was attributed to chronic allograft nephropathy.
Kidney International (2007) 71
5