Rodrigo Aliaga M, Morera Martínez J, López Alcina E, Broseta Rico E, Oliver Amorós F, Boronat Tormo F, Sánchez Plumed J, Jiménez Cruz J F
Servicio de Urología, Hospital Universitario La Fe, Valencia, España.
Arch Esp Urol. 1996 Dec;49(10):1063-70.
The formation of calculus in the transplanted kidney is an uncommon complication. Metabolic derangements, infectious or obstructive processes, factors related with the surgical technique and the presence of ureteral catheters have been implicated in its etiopathogenesis. The therapeutic possibilities have changed in the last decade. The different factors related with stone formation in the transplanted kidney, the indications and treatment utilized in each case are analyzed.
We analyzed the cases of lithiasis following renal transplantation in our series of 800 renal transplants. The metabolic anomalies and other associated lithogenic factors in 5 cases that required treatment are described.
All 5 patients were treated by ESWL. Complete resolution of the lithiasis was achieved in 4 cases whose kidney graft is currently stone free with preserved renal function, except one patient with hyperuricemia and hyperuricosuria who is again on hemodialysis for chronic rejection. In the fifth case fragmentation of the caliceal stone was not achieved after 4 sessions of ESWL. Subsequem ultrasound control evaluations have disclosed no changes in stone size or location.
In our view, the approach to renal lithiasis in the transplanted kidney is similar to that of patients with solitary kidney, although stone size for treatment by ESWL should be limited to 2 cms. If stone size is between 1 and 2 cms, placement of a double-J catheter prior to ESWL is recommended, whenever possible. For stones larger than 2 cms, percutaneous nephrolithotomy is more effective and has less complications. Surgery is reserved for those patients in whom these techniques are unamenable or have failed.
移植肾内结石形成是一种罕见的并发症。代谢紊乱、感染或梗阻性病变、与手术技术相关的因素以及输尿管导管的存在均与其发病机制有关。在过去十年中，治疗方法发生了变化。本文分析了与移植肾结石形成相关的不同因素，以及每种情况下的治疗指征和治疗方法。
我们分析了我院800例肾移植患者中发生结石的病例。描述了5例需要治疗的患者的代谢异常及其他相关结石形成因素。
所有5例患者均接受了体外冲击波碎石术（ESWL）治疗。4例患者结石完全清除，目前移植肾无结石且肾功能良好，只有1例高尿酸血症和高尿酸尿症患者因慢性排斥反应再次接受血液透析。第5例患者在接受4次ESWL治疗后，肾盏结石未破碎。随后的超声检查评估显示结石大小和位置均无变化。
我们认为，移植肾结石的治疗方法与孤立肾患者相似，不过ESWL治疗的结石大小应限制在2厘米以内。如果结石大小在1至2厘米之间，尽可能在ESWL治疗前放置双J导管。对于大于2厘米的结石，经皮肾镜取石术更有效且并发症更少。手术仅适用于那些无法采用这些技术或治疗失败的患者。
