Ureter in renal transplantation

Sonographic evaluation of the rejecting ureter

In 10 mongrel dogs, the sonographic features of the pelvocaliceal system and ureteral peristalsis during acute rejection were correlated with the electromyographic (EMG) findings and histologic appearance. There were significant alterations of the ureteral dynamics during rejection as demonstrated by changes in the pressure tracings, the progressive decrease of electrical activity of the ureteral muscle, and decreased peristalsis with pelvicaliectasis as demonstrated on real-time ultrasound. The sonographic changes of peripelvic and periureteral thickening corresponded to histologic changes of edema and inflammatory infiltrate with disruption of the muscular layer. In the presence of clinical and sonographic findings of kidney rejection, the demonstration of hydronephrosis and thickened pelvic wall should be considered as another measure of the rejection process.

Transplant ureteral obstruction masquerading as recurrent rejection episodes: management by percutaneous antegrade balloon dilatation

We report a 52-year-old male renal transplant recipient who had three "rejection episodes." The first of these responded to conventional antirejection therapy; however, the next two episodes showed incomplete responses to treatment for rejection. At subsequent presentation with deteriorating renal function, ureteral obstruction was evident and was relieved with percutaneous antegrade balloon dilatation with a return of his plasma creatinine to normal. Obstruction of the ureter was a major component in our patient's course given the lack of response to conventional antirejection therapy and the normalization of renal function with relief of the documented ureteral stenosis. This case illustrates that ureteral obstruction can mimic rejection in the renal transplant recipient. Management of ureteral stenosis in transplant patients with percutaneous antegrade balloon dilatation appears to be an effective procedure and can supplant the need for open surgical procedures.

Recipient ureterocalycostomy in a renal allograft: case report of a transplant salvage

The use of a recipient ureter ureterocalycostomy in the management of ureteral obstruction in a renal transplant recipient is presented. This technique can be used when primary modes of reconstruction are unavailable and nephrectomy is the only alternative.

Marked azotemia and increase in serum creatinine: case report of an unusual feature of acute ureteral obstruction in a renal allograft recipient

A patient is described who presented with late ureteral necrosis following renal transplantation, a complication that usually is seen in the early perioperative period. The patient was anuric with azotemia and a high serum creatinine. Response to surgical correction of ureteral obstruction was excellent and renal function returned to normal within 6 days postoperatively.

The clinical significance of dilatation of the collecting system in the transplanted kidney

The significance of dilatation of the collecting system of the transplanted kidney and its relationship to bladder distention was reviewed in 39 renal recipients examined by sonography (94 studies). The degree of pelvicaliceal (PCS), ureteral, and bladder distention was graded and correlated with the 24-h urine output, nuclear renal scan, and clinical follow-up. marked PCS distention can indicate obstruction (33%), especially when there is no associated bladder distention (60%) and a fluid collection lies along the path of the ureter. The 24-hr urine output did not influence the degree of PCS distention.

The use of percutaneous antegrade renal perfusion in kidney transplant recipients

Percutaneous antegrade renal perfusion under ultrasound control may be performed safely in human renal transplant recipients with dilated pelviocaliceal systems. The study can be useful to define whether the presence of anatomic changes is accompanied by significant functional obstruction.