Mini-percutaneous nephrolithotomy via ultrasound guidance in transplanted kidney: a report of two cases

Acute renal failure after kidney transplantation due to mizoribine-induced ureteral stones

INTRODUCTION

Mizoribine (MZR) is used to prevent rejection reactions after kidney transplantation and increase the risk of hyperuricemia. There is a lack of reports of MZR-induced ureteral stones after kidney transplantation. The surgery treatment of ureteral stones in transplanted kidney is a challenging clinical issue that should only be performed by experienced urologists at professional centers. It is very important to have a thorough understanding of the patient's medical history, analyze the causes of stone formation, and choose a reasonable treatment plan based on the characteristics of the stones. The case report is aim to emphasize the recognition of the possibility of mizoribine-induced ureteral uric acid stones in transplanted kidney and to avoid unnecessary surgery.

CASE PRESENTATION

A patient after kidney transplantation was diagnosed with acute renal failure caused by ureteral stones. The medical history, CT images of the renal graft, the results of laboratory test and stone composition analysis were provided. Based on medical history and laboratory test results, it was determined that the ureteral stones of renal graft was induced by MZR. To our best knowledge, this is the first report of MZR-induced stones in transplanted kidney and ureters. It was completely cured by urinary alkalinization, avoiding surgery treatment. We summarize the characteristics, treatment and methods for preventing the formation of uric acid stones of patients with MZR.

CONCLUSION

By analyze our case report, it shows that acute renal failure with ureteral stones after kidney transplantation can caused by MZR. Urinary alkalinization for MZR induced uric acid stones is simple and effective.

Percutaneous nephrolithotomy for management neglected encrusted ureteral stent in a transplanted kidney: a case report

Retrieving these forgotten encrusted double j (DJ) stents could be challenging and require multimodal urological interventions, especially in a single-functioning transplanted kidney. Only a few cases of mini-percutaneous nephrolithotomy (mini-PCNL) via ultrasonography (US) guidance in transplanted kidneys have been published. We report a 47-year-old man; a case of a transplanted kidney, with a complaint of abdominal pain and dysuria for two weeks. The patient had a forgotten DJ stent for more than a year due to a lack of post-procedural follow-up information. An abdominal computed tomography scan showed a 20 x 13mm stone in the proximal tip of the DJ stent. Ultrasonography-guided mini-PCNL with a 19-fr rigid nephroscope was performed without complications. In conclusion, we emphasize the importance of patient education regarding the indwelling DJ stent. This case also provides that if an experienced urologist performs it, the US-guided mini-PCNL is safe and effective in transplanted kidney patients.