Ewha Med J.  2015 Oct;38(3):117-120. 10.12771/emj.2015.38.3.117.

Hypocitraturia-related Ureteral Steinstrasse in a Renal Transplant Recipient

• Na JG
• Kong SM
• Lee DG
• Kim SM
• Jang Y
• Kim SR
• Lee YJ

• KMID: 2171348
• DOI: http://doi.org/10.12771/emj.2015.38.3.117

Abstract

Urolithiasis is an uncommon complication in renal transplantation. We report a case of hypocitraturia-related ureteral steinstrasse which was spontaneously formed in a renal transplant recipient. The patient who underwent renal transplantation was admitted with acute pyelonephritis. Hydronephrosis in the transplanted kidney and multiple stones (steinstrasse) in the distal ureter were incidentally found on computed tomography scanning. After a failed attempt of ureteroscopic removal of stones, the patient underwent open ureterolithotomy and ureteroureterostomy. On stone analysis, carbonate apatite was confirmed. Urinary citric acid levels were decreased to 127.6 mg/day. Potassium citrate was administered to prevent stone recurrence by increasing urinary citrate excretion. No recurrence of stones was shown six months later. Urolithiasis in renal transplant recipients requires a high index of suspicion. Hypocitraturia can increase the risk for urolithiasis. Rapid recognition by careful surveillance, prompt removal of stones, and precautionary efforts to prevent recurrence are needed.

Keyword

Citric acid; Renal transplantation; Ureter; Stones

MeSH Terms

Carbon
Citric Acid
Humans
Hydronephrosis
Kidney
Kidney Transplantation
Potassium Citrate
Pyelonephritis
Recurrence
Transplantation*
Ureter*
Urolithiasis
Carbon
Citric Acid
Potassium Citrate

Figure

• 

  Fig. 1 Initial radiologic findings. (A) The plain film of the abdomen reveals radiopaque stones in the pelvic cavity (arrow). (B) Computed tomography scan shows hydroureteronephrosis in transplanted kidney and multiple stones in the distal ureter (steinstrasse).

• 

  Fig. 2 Computed tomography after six months. It show no stones in transplanted kidney and ureter.

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