Skip to main content

Advertisement

SpringerLink
Log in

Minimally invasive treatment of renal transplant nephrolithiasis

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Urolithiasis is a rare complication of renal transplantation, and there is limited evidence to guide treatment. Management of stones in the transplanted kidney can be challenging. We present our experience in treating upper urinary tract (UUT) allograft lithiasis using minimally invasive procedures, with the aim of demonstrating their efficacy and safety in renal transplant recipients.

Methods

The records of 1615 patients undergoing kidney transplantation and follow-up in our center between August 2000 and July 2014 were reviewed. The mode of presentation, donor type, onset time, immunosuppression protocol, stone character, therapeutic intervention and outcomes of those with UUT allograft lithiasis were recorded. Extracorporeal shock wave lithotripsy (SWL), flexible ureteroscopy (F-URS) and percutaneous nephrolithotomy (PCNL) were used in the management of these calculi. Stone composition was analyzed after the procedure.

Results

Nineteen renal transplant recipients (1.2 %, nine males and ten females) were found to have UUT allograft calculi. Of these, five underwent SWL (26.3 %), four had F-URS combined with lithotomy forceps extraction or holmium laser disruption (21.1 %), six had PNCL (31.6 %), one submitted to F-URS after two failed sessions of SWL (5.3 %), one combined PCNL and F-URS (5.3 %), and two spontaneously of stones (10.5 %). All patients were rendered stone-free with a combination of treatments, and none required a blood transfusion.

Conclusions

The incidence of calculi in the transplanted kidney is low. Minimally invasive procedures are safe and effective means of removing allograft calculi.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

UUT:

Upper urinary tract

UTIs:

Urinary tract infection

SWL:

Shock wave lithotripsy

F-URS:

Flexible ureteroscopy

PCNL:

Percutaneous nephrolithotomy

KUB:

Kidney, ureter and bladder

CsA:

Cyclosporine

MMF:

Mycophenolate mofetil

Tac:

Tacrolimus

P:

Prednisone

References

  1. Meier-Kriesche HU, Ojo AO, Port FK, Arndorfer JA, Cibrik DM, Kaplan B (2001) Survival improvement among patients with end-stage renal disease: trends over time for transplant recipients and wait-listed patients. J Am Soc Nephrol 12(6):1293–1296

    CAS  PubMed  Google Scholar 

  2. Meier-Kriesche HU, Kaplan B (2001) Cyclosporine microemulsion and tacrolimus are associated with decreased chronic allograft failure and improved long-term graft survival as compared to Sandimmune. Transplant Proc 33(7–8):3422–3423. doi:10.1016/S0041-1345(01)02475-7

    Article  CAS  PubMed  Google Scholar 

  3. Lu HF, Shekarriz B, Stoller ML (2002) Donor-gifted allograft urolithiasis: early percutaneous management. Urology. doi:10.1016/S0090-4295(01)01490-X

    Google Scholar 

  4. Rhee BK, Bretan PN Jr, Stoller ML (1999) Urolithiasis in renal and combined pancreas/renal transplant recipients. J Urol. doi:10.1016/S0022-5347(05)68926-4

    PubMed  Google Scholar 

  5. Zavos G, Pappas P, Karatzas T, Karidis NP, Bokos J, Stravodimos K, Theodoropoulou E, Boletis J, Kostakis A (2008) Urological complications: analysis and management of 1525 consecutive renal transplantations. Transplant Proc 40(5):1386–1390. doi:10.1016/j.transproceed.2008.03.103

    Article  CAS  PubMed  Google Scholar 

  6. Van Gansbeke D, Zalcman M, Matos C, Simon J, Kinnaert P, Struyven J (1985) Lithiasic complications of renal transplantation: the donor graft lithiasis concept. Urol Radiol 7(1):157–160. doi:10.1007/BF02926876

    Article  PubMed  Google Scholar 

  7. Hobart MG, Streem SB, Gill IS (2000) Renal transplant complications. Minimally invasive management. Urol Clin North Am 27(4):787–798

    Article  CAS  PubMed  Google Scholar 

  8. Konnak JW, Herwig KR, Finkbeiner A, Turcotte JG, Freier DT (1975) Extravesical ureteroneocystostomy in 170 renal transplant patients. J Urol 113(3):299–301

    CAS  PubMed  Google Scholar 

  9. Starzl TE, Groth CG, Putnam CW, Penn I, Halgrimson CG, Flatmark A, Gecelter L, Brettschneider L, Stonington OG (1970) Urological complications in 216 human recipients of renal transplants. Ann Surg 172(1):1–22

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Norman DJ, Bennett WM, Wetzsteon PJ, Hefty T, Meyer MM, Tolzman D, Seely M, Millhollen M, Barry JM (1991) Outcome of renal transplantation at Oregon Health Sciences University: 1982 to 1990. Clin Transpl 153–157

  11. Evenepoel P, Lerut E, Naesens M, Bammens B, Claes K, Kuypers D, Vermeersch P, Meijers B, Van Damme B, Vanrenterghem Y (2009) Localization, etiology and impact of calcium phosphate deposits in renal allografts. Am J Transplant 9(11):2470–2478. doi:10.1111/j.1600-6143.2009.02792.x

    Article  CAS  PubMed  Google Scholar 

  12. Gupta M, Lee MW (2007) Treatment of stones associated with complex or anomalous renal anatomy. Urol Clin North Am 34(3):431–441. doi:10.1016/j.ucl.2007.04.004

    Article  PubMed  Google Scholar 

  13. Krambeck AE, Leroy AJ, Patterson DE, Gettman MT (2008) Percutaneous nephrolithotomy success in the transplant kidney. J Urol 180(6):2545–2549. doi:10.1016/j.juro.2008.08.032

    Article  PubMed  Google Scholar 

  14. Harper JM, Samuell CT, Hallson PC, Wood SM, Mansell MA (1994) Risk factors for calculus formation in patients with renal transplants. Br J Urol 74(2):147–150

    Article  CAS  PubMed  Google Scholar 

  15. Caralps A, Lloveras J, Masramon J, Andreu J, Brulles A, Gil-Vernet JM (1977) Urinary calculi after renal transplantation. Lancet 1(8010):544

    Article  CAS  PubMed  Google Scholar 

  16. Dumoulin G, Hory B, Nguyen NU, Henriet MT, Bresson C, Bittard H, Saint-Hillier Y, Regnard J (1997) Lack of increased urinary calcium-oxalate supersaturation in long-term kidney transplant recipients. Kidney Int 51(3):804–810. doi:10.1038/ki.1997.113

    Article  CAS  PubMed  Google Scholar 

  17. Braren V, McNamara TC, Johnson HK, Teschan PE, Richie RE (1978) Urinary tract calculous disease after renal transplantation. Urology 12(4):402–406

    Article  CAS  PubMed  Google Scholar 

  18. Cho DK, Zackson DA, Cheigh J, Stubenbord WT, Stenzel KH (1988) Urinary calculi in renal transplant recipients. Transplantation 45(5):899–902

    Article  CAS  PubMed  Google Scholar 

  19. Srivastava A, Zaman W, Singh V, Mandhani A, Kumar A, Singh U (2004) Efficacy of extracorporeal shock wave lithotripsy for solitary lower calyceal stone: a statistical model. BJU Int 93(3):364–368. doi:10.1111/j.1464-410X.2003.04618.x

    Article  CAS  PubMed  Google Scholar 

  20. Ferreira Cassini M, Cologna AJ, Ferreira Andrade M, Lima GJ, Medeiros Albuquerque U, Pereira Martins AC, Tucci Junior S (2012) Lithiasis in 1,313 kidney transplants: incidence, diagnosis, and management. Transplant Proc 44(8):2373–2375. doi:10.1016/j.transproceed.2012.07.052

    Article  CAS  PubMed  Google Scholar 

  21. Markic D, Valencic M, Grskovic A, Spanjol J, Sotosek S, Fuckar Z, Maricic A, Pavlovic I, Budiselic B (2011) Extracorporeal shockwave lithotripsy of ureteral stone in a patient with en bloc kidney transplantation: a case report. Transplant Proc 43(5):2110–2112. doi:10.1016/j.transproceed.2011.03.031

    Article  CAS  PubMed  Google Scholar 

  22. Hyams E, Marien T, Bruhn A, Quirouet A, Andonian S, Shah O, Matlaga B (2012) Ureteroscopy for transplant lithiasis. J Endourol 26(7):819–822. doi:10.1089/end.2011.0495

    Article  PubMed  Google Scholar 

  23. Crook TJ, Keoghane SR (2005) Renal transplant lithiasis: rare but time-consuming. BJU Int 95(7):931–933. doi:10.1111/j.1464-410X.2005.05481.x

    Article  PubMed  Google Scholar 

  24. Basiri A, Nikoobakht MR, Simforoosh N, Hosseini Moghaddam SM (2006) Ureteroscopic management of urological complications after renal transplantation. Scand J Urol Nephrol 40(1):53–56. doi:10.1080/00365590510007838

    Article  CAS  PubMed  Google Scholar 

  25. Resorlu B, Unsal A (2012) Flexible ureterorenoscopy versus extracorporeal shockwave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int 110(2):E5. doi:10.1111/j.1464-410X.2012.11301.x

    Article  PubMed  Google Scholar 

  26. Giusti G, Proietti S, Peschechera R, Taverna G, Sortino G, Cindolo L, Graziotti P (2014) Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol. doi:10.1007/s00345-014-1345-y

    Google Scholar 

  27. Del Pizzo JJ, Jacobs SC, Sklar GN (1998) Ureteroscopic evaluation in renal transplant recipients. J Endourol 12(2):135–138

    Article  PubMed  Google Scholar 

  28. Hulbert JC, Reddy P, Young AT, Hunter DW, Castaneda-Zuniga W, Amplatz K, Lange PH (1985) The percutaneous removal of calculi from transplanted kidneys. J Urol 134(2):324–326

    CAS  PubMed  Google Scholar 

  29. Wong KA, Sahai A, Patel A, Thomas K, Bultitude M, Glass J (2013) Is percutaneous nephrolithotomy in solitary kidneys safe? Urology 82(5):1013–1016. doi:10.1016/j.urology.2013.06.034

    Article  PubMed  Google Scholar 

  30. He Z, Li X, Chen L, Zeng G, Yuan J (2007) Minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi in transplanted kidneys. BJU Int 99(6):1467–1471. doi:10.1111/j.1464-410X.2007.06768.x

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported financially by the Foundation for Science and Technology Development Project of Shandong Province, China.

Conflict of interest

All authors declare no conflict of interest.

Ethical standard

The retrospective review of medical records was approved by the Research Ethics Committee of Yantai Yuhuangding Hospital affiliated to the Medical College of Qingdao University and performed in accordance with the Declaration of Helsinki and its amendments. We obtained written informed consent from all participants involved in our study. Any information that could identify individual subjects has been removed.

Author information

Author notes

    Authors and Affiliations

    1. Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong Province, China

      He-jia Yuan, Dian-dong Yang, Yuan-shan Cui, Chang-ping Men, Zhen-li Gao, L. Shi & Ji-tao Wu

    Authors
    1. He-jia Yuan
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Dian-dong Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yuan-shan Cui
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Chang-ping Men
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Zhen-li Gao
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. L. Shi
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Ji-tao Wu
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Ji-tao Wu.

    Additional information

    He-jia Yuan and Dian-dong Yang contributed equally to this paper.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Yuan, Hj., Yang, Dd., Cui, Ys. et al. Minimally invasive treatment of renal transplant nephrolithiasis. World J Urol 33, 2079–2085 (2015). https://doi.org/10.1007/s00345-015-1549-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00345-015-1549-9

    Keywords

    Search

    Navigation