Zeng Min-Ming, Kwan Kristine Joy Shan, Tang Jun-Feng, Wen Xiang-Yang, Xiong Lin
Department of Urology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, Guangdong, China.
Department of Vascular Surgery, Fudan University Pudong Medical Center, Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China.
Am J Case Rep. 2025 Jan 1;26:e946224. doi: 10.12659/AJCR.946224.
BACKGROUND Transplant lithiasis may be rare but poses significant risk to the renal graft function of the recipient. Immediate management is necessitated upon first detection, to prevent further complications. CASE REPORT We report 2 cases of transplant lithiasis that were not treated immediately upon first detection. The first patient was a 42-year-old man that received a living-donor kidney from his mother, which was complicated by ureterovesical anastomotic stenosis, BK polyomavirus infection, and oliguria. He had a renal stone and 4 ureteric stones in his right allograft. The second patient was a 39-year-old man that finally received a suitable deceased donor kidney after 6 years of dialysis. A 2-3-mm stone was first detected 6 months after transplantation but was managed conservatively. He required management 8 years after transplantation, due to the presence of 2 renal stones and 4 ureteric stones in the left allograft that led to acute renal failure. Both patients required emergent percutaneous nephrolithotomy for decompression, followed by elective antegrade flexible ureteroscopic lithotripsy. Boot stirrups were used throughout all procedures to facilitate access to the lower-positioned transplant kidney. Complete stone clearance was achieved, as detected by a 1-month postoperative follow-up computed tomography scan. CONCLUSIONS Percutaneous nephrolithotomy and antegrade flexible ureteroscopic lithotripsy was a safe and effective approach for complex transplant lithiasis. Very low lithotomy with boot stirrups improved accessibility to the transplant kidney.
移植肾结石可能较为罕见，但会对受者的肾移植功能构成重大风险。首次发现后必须立即进行处理，以防止进一步的并发症。病例报告：我们报告2例移植肾结石病例，首次发现时未立即进行治疗。首例患者为一名42岁男性，接受了来自其母亲的活体供肾，术后并发输尿管膀胱吻合口狭窄、BK多瘤病毒感染及少尿。其右移植肾有1枚肾结石和4枚输尿管结石。第二例患者为一名39岁男性，在透析6年后最终接受了合适的尸体供肾。移植后6个月首次发现一枚2 - 3毫米的结石，当时采取了保守治疗。移植8年后，因其左移植肾出现2枚肾结石和4枚输尿管结石并导致急性肾衰竭，需要进行治疗。两名患者均需要紧急行经皮肾镜取石术减压，随后择期行顺行性软性输尿管镜碎石术。在所有手术过程中均使用了靴形马镫以方便接近位置较低的移植肾。术后1个月的计算机断层扫描显示结石完全清除。结论：经皮肾镜取石术和顺行性软性输尿管镜碎石术是治疗复杂性移植肾结石的一种安全有效的方法。使用靴形马镫的极低截石位改善了对移植肾的暴露。
