Renal allograft dysfunction secondary to ureterolithiasis: Diagnosis and management

• Main Authors: Priyank Yadav, Sohrab Arora, Mousam Dey, Tushant Kumar, Hira Lal, Narayan Prasad, Aneesh Srivastava
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2016-01-01
• Series: Indian Journal of Transplantation
• Subjects: Graft hydronephrosis; Ureteric calculi; Graft dysfunction; Graft ureterolithotripsy
• Online Access: http://www.ijtonline.in/article.asp?issn=2212-0017;year=2016;volume=10;issue=2;spage=49;epage=51;aulast=Yadav;type=0

Urolithiasis is one of the most common conditions seen in urology practice. Renal transplantation is associated with a lower incidence of urolithiasis compared to general population. In these patients, the incidence of isolated ureteric calculi is 5–10 times lower than renal calculi. If renal and/or ureteric calculi are present in transplanted kidney, they must be attended urgently as the presentation in such patients is atypical due to lack of sympathetic innervation of the graft kidney and the condition may rapidly progress to graft dysfunction. The diagnosis of renal and upper ureteric calculi is usually made on graft ultrasonography. For mid and distal ureteric calculi, CT and MR urography are more sensitive. For nonobstructive calculi, treatment is with extracorporeal shock wave lithotripsy (ESWL) or flexible ureteroscopic removal for smaller stone burden (<1.5 cm) while obstructive calculi and larger stones are best addressed with percutaneous nephrostomy followed by percutaneous nephrolithotomy (PCNL) or ESWL or endoscopic removal.