Donor kidney lithiasis and back-table endoscopy: a successful combination

A case of a transplanted kidney with an orthotopic kidney stone

A 39-year-old man was admitted to our hospital with kidney stones after kidney transplantation. Kidney, ureter, and bladder radiographs showed multiple stones in the transplanted and orthotopic kidneys, which had not been reported previously. Owing to the larger size of the stones in the transplanted kidney, they needed to be removed. Percutaneous nephrolithotomy and ureteroscopy were performed under B-mode ultrasound guidance. The stone measured 1.9 × 1.6 cm and was located under the calyx of the kidney. A titanium laser fiber was used to dissolve the stones, which were subsequently removed. No adverse reactions occurred during or after the surgery. The causes of stone formation included dietary factors, related drugs, improper fluid intake, and urinary tract infections. As neither the donor nor the recipient had a history of kidney stones, we hypothesized that the stones were a new entity that either developed following transplantation or a long-term complication.

Urolithiasis in Kidney Transplant Patients: A Multicenter KSER Research Series

Background and Objectives: Urolithiasis occurrence is uncommon in kidney transplantation patients, though it has serious implications, including acute kidney injury in the transplanted kidney. This study investigates the leading causes of urolithiasis in kidney transplantation patients, the diagnostic process, and the outcomes of multimodal management. Materials and Methods: Data collection spanned from January 1997 to December 2021, involving kidney transplantation patients with urolithiasis from the database of the Korean Society of Endourology and Robotics (KSER) research committee. Analysis encompassed factors triggering urolithiasis, the diagnostic process, stone attributes, treatment methods, and outcomes. Results: Our analysis included 58 kidney transplantation patients with urolithiasis from eight medical centers. Of these patients, 37 were male and 4 had previous urolithiasis diagnoses. The mean age was 59.09 ± 10.70 years, with a mean duration from kidney transplantation to diagnosis of 76.26 ± 183.14 months. The most frequent method of stone detection was through asymptomatic routine check-ups (54.7%). Among the 58 patients, 51 underwent stone treatment. Notably, 95.3% of patients with ureter stones received treatment, a significantly higher rate than the 66.7% of patients with renal stones (p = 0.010). Success rates showed no significant differences between renal (70%) and ureter stone (78.0%) groups (p = 0.881). Conclusions: Urolithiasis in transplanted kidneys constitutes an acute condition requiring emergency intervention. Endo-urological interventions are effective for kidney transplantation patients with urolithiasis. To ensure prevention and early detection, diligent follow-up and routine imaging tests are necessary.