Lancina Martín J A, García Buitrón J M, Díaz Bermúdez J, Alvarez Castelo L, Duarte Novo J, Sánchez Merino J M, Rubial Moldes M, González Martín M
Servicio de Urología, Hospital Juan Canalejo, La Coruña, España.
Arch Esp Urol. 1997 Mar;50(2):141-50.
We reviewed the records of patients submitted to renal transplantation at our institution to determine the incidence and risk factors for calculus formation in these patients.
Of 794 functioning renal grafts that had been transplanted from January, 1981 to May, 1996, 16 patients (2%), 9 males and 7 females, had upper urinary tract calculi post-transplantation. All 16 patients had received kidneys from cadaver donors. Three had donor graft lithiasis. The calculi were located predominantly in the calyces, at multiple sites in 7 patients and the mean size was 8.3 mm. The composition of the calculi was predominantly uric acid. Four patients who developed sudden obstructive anuria with elevated serum creatinine, underwent percutaneous drainage.
All patients had one or more stone-predisposing factors, such as obstructive uropathy, recurrent urinary tract infection or metabolic abnormalities (predominantly hyperuricosuria). Five patients passed their stones spontaneously, 7 patients with uric acid stones were treated with urinary alkalinization, two patients underwent open pyelolithotomy, one underwent percutaneous nephrolithotomy and one patient with a small asymptomatic caliceal stone was managed conservatively (watchful waiting). During long-term follow-up (mean 69 months), 4 patients lost the real graft [only one case was related to urinary calculi (primary hyperoxaluria)] and 4 patients had recurrent calculi.
Urinary lithiasis after renal transplantation is a relatively uncommon complication. A multifactorial etiology for calculus formation has been observed. The predisposing factors and composition of the calculi, but not frequency, are identical to those of non-transplant patients. A variety of methods are used to treat posttransplant calculi. The least invasive treatment available should be utilized according to the likelihood of recurrence and the need to preserve renal function. With adequate treatment and prophylaxis, posttransplant urolithiasis does not appear to affect graft function.
我们回顾了在我院接受肾移植患者的记录，以确定这些患者结石形成的发生率及危险因素。
在1981年1月至1996年5月间移植的794个有功能的肾移植物中，16例患者（2%），9例男性和7例女性，在移植后发生上尿路结石。所有16例患者均接受尸体供肾。3例供肾有结石。结石主要位于肾盏，7例患者为多发，平均大小为8.3毫米。结石成分主要为尿酸。4例出现突然梗阻性无尿且血清肌酐升高的患者接受了经皮引流。
所有患者均有一个或多个结石易感因素，如梗阻性尿路病、复发性尿路感染或代谢异常（主要为高尿酸尿症）。5例患者结石自行排出，7例尿酸结石患者接受了尿液碱化治疗，2例患者接受了开放性肾盂切开取石术，1例接受了经皮肾镜取石术，1例无症状小肾盏结石患者采取了保守治疗（密切观察）。在长期随访（平均69个月）中，4例患者失去了移植肾[仅一例与尿路结石有关（原发性高草酸尿症）]，4例患者结石复发。
肾移植后尿路结石是一种相对少见的并发症。已观察到结石形成有多种病因。结石的易感因素和成分与非移植患者相同，但发生率不同。治疗移植后结石有多种方法。应根据复发可能性及保留肾功能的需要采用创伤最小的治疗方法。通过适当的治疗和预防，移植后尿路结石似乎不影响移植肾功能。
