Henderickx Michaël M E L, Baard Joyce, Wesselman van Helmond Pauline C, Jansen Ilaria, Kamphuis Guido M
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Acta Chir Belg. 2023 Apr;123(2):170-173. doi: 10.1080/00015458.2021.1934333. Epub 2021 May 31.
Urolithiasis in renal allografts is relatively rare with an incidence of 0.17-4.40%. It is nonetheless an important issue, as there is a risk of obstruction, sepsis and even loss of the renal allograft. The management of stones in renal allografts remains challenging because of the anatomy, the renal denervation and the use of immunosuppressive medication.
This report discusses the treatment of asymptomatic nephrolithiasis in a living donor kidney allograft. A CT abdomen revealed a lower pole stone (5.9 × 5.5 × 5.0 mm; 920 HU) in the right kidney of the potential donor. After multidisciplinary discussion, it was decided to procure the right kidney despite the presence of a documented nephrolithiasis. After discussion with both donor and recipient, an flexible ureterorenoscopy for stone removal on the back table just before implantation of the allograft was planned. The stone was found in the lower pole covered by a thin film of the urothelium. The thin film of urothelium was opened with a laser and the stone fragments were retrieved with a basket. CT after one month showed no residual stones in the transplanted kidney.
Back-table endoscopy in a renal allograft is a feasible technique and should be discussed as an option in case of urolithiasis in a kidney that is considered for transplantation. Furthermore, the appropriate treatment of donor kidney lithiasis is another, although rare, method to expand the living donor renal allograft pool.
肾移植中尿路结石相对少见，发病率为0.17%-4.40%。然而，这仍是一个重要问题，因为存在梗阻、脓毒症甚至肾移植丢失的风险。由于解剖结构、肾去神经支配及免疫抑制药物的使用，肾移植中结石的处理仍具有挑战性。
本报告讨论了一例活体供肾移植受者无症状肾结石的治疗。腹部CT显示潜在供者右肾下极有一枚结石（5.9×5.5×5.0mm；920HU）。经过多学科讨论，尽管有记录在案的肾结石，仍决定获取右肾。在与供者和受者讨论后，计划在移植前在手术台上通过软性输尿管肾镜取石。结石位于下极，被一层薄薄的尿路上皮覆盖。用激光打开尿路上皮薄膜，并用网篮取出结石碎片。术后1个月的CT显示移植肾无残留结石。
肾移植术中手术台上的内镜检查是一种可行的技术，对于考虑用于移植的肾脏出现尿路结石的情况，应将其作为一种选择进行讨论。此外，对供肾结石进行适当治疗是扩大活体供肾移植库的另一种方法，尽管这种情况很少见。
