Abstract
Polyuria is not considered an absolute indication for pre-transplant nephrectomy; however, it may complicate post-transplantation fluid management. Bilateral native-kidney laparoscopic nephrectomy was performed at our centre in two patients (four kidneys) 1 month after they had received a living related-donor renal transplant. The indication for nephrectomy was severe post-transplant polyuria secondary to the patient’s underlying disease: juvenile nephronophthisis. Both patients had a persistent post-transplant daily urine output of 7–8 l/day and continued to have a variable serum creatinine level, dependent on intravenous hydration, more then 3 weeks after transplantation. Bilateral laparoscopic native-kidney nephrectomy in children has previously been reported. However, to the best of our knowledge, laparoscopic nephrectomy has not been described after kidney transplantation and certainly not in the immediate post-transplantation period. The procedure was well tolerated and did not affect renal graft function. In fact, following the procedure, serum creatinine levels stabilized, while daily fluid requirements decreased to 2.5–3.5 l/day in both patients. We concluded that bilateral native-kidney nephrectomy can be safely performed in paediatric renal transplant recipients in the immediate post-transplantation period. This new approach may allow preemptive transplantation and avoid the need for a transition period on dialysis in patients for whom pre-transplant nephrectomy is not absolutely indicated.
References
Langlois V, Geary D, Murray L, Champoux S, Hebert D, Goodyer P (2000) Polyuria and proteinuria in cystinosis have no impact on renal transplantation. A report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 15:7–10
Singh A, Stablein D, Tejani A (1997) Risk factors for vascular thrombosis in pediatric renal transplantation. Transplantation 63:1263–1267
EBPG Expert Group on Renal Transplantation (2002) European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.11 Paediatrics (specific problems). Nephrol Dial Transplant 17 [Suppl 4]:55–58
Matas AJ, Chavers BM, Nevins TE, Mauer SM, Kashtan CE, Cook M, Najarian JS (1996) Recipient evaluation, preparation, and care in pediatric transplantation: the University of Minnesota protocols. Kidney Int Suppl 53:S99–S102
York GB, Robertson FM, Cofer BR, Bomalaski MD, Lynch SC (2000) Laparoscopic nephrectomy in children. Surg Endosc 14:469–472
Hamilton BD, Gatti JM, Cartwright PC, Snow BW (2000) Comparison of laparoscopic versus open nephrectomy in the pediatric population. J Urol 163:937–939
Robinson BC, Snow BW, Cartwright PC, De Vries CR, Hamilton BD, Anderson JB (2003) Comparison of laparoscopic versus open partial nephrectomy in a pediatric series. J Urol 169:638–640
Booth C, Mushtaq I, Rigden S (2004) Bilateral laparoscopic nephrectomy with simultaneous peritoneal dialysis: a new era. Pediatr Nephrol 19:932–934
Harrel WB, Snow BW (2005) Minimally invasive pediatric nephrectomy. Curr Opin Urol 15:277–281
David-Walek T, Steinhoff J, Fricke L, Sack K (1998) Excessive polyuria after renal transplantation. Nephron 78:334–335
Hildebrandt F, Omram H (2001) New insights: nephronophthisis–medullary cystic kidney disease. Pediatr Nephrol 16:168–176
Stifelman MD, Hull D, Sosa E, SU LM, Hyman M, Stubenbord W, Shichman S (2001) Hand assisted laparoscopic nephrectomy: a comparison with the open approach. J Urol 166:444–448
Ruiz-Deya G, Cheng S, Palmer E, Thomas R, Slakey D (2001) Open donor, laparoscopic donor and hand assisted laparoscopic donor nephrectomy: a comparison of outcomes. J Urol 166:1270–1274
Wolf JS Jr, Tchetgen MB, Merion RM (1998) Hand-assisted laparoscopic living donor nephrectomy. Urology 52:885–887
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kravarusic, D., Sigalet, D.L., Hamiwka, L.A. et al. Persistent post-transplant polyuria managed by bilateral native-kidney laparoscopic nephrectomy. Pediatr Nephrol 21, 880–882 (2006). https://doi.org/10.1007/s00467-006-0085-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-006-0085-7