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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 176-177
 

Tuberculous pyonephrosis of native kidney in a transplant recipient 16 years after the ligation of the native ureter


Department of Urology and Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India

Correspondence Address:
PVLN Murthy
Department of Urology, Nizam's Institute of Medical Sciences, Hyderabad - 500 082
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Tuberculous pyonephrosis, pyeloureterostomy, ureteroureterostomy.


How to cite this article:
Murthy P, Prakash S, Nandkumar, Reddy R, Dakshina Murthy K V. Tuberculous pyonephrosis of native kidney in a transplant recipient 16 years after the ligation of the native ureter. Indian J Urol 2004;20:176-7

How to cite this URL:
Murthy P, Prakash S, Nandkumar, Reddy R, Dakshina Murthy K V. Tuberculous pyonephrosis of native kidney in a transplant recipient 16 years after the ligation of the native ureter. Indian J Urol [serial online] 2004 [cited 2019 Jun 17];20:176-7. Available from: http://www.indianjurol.com/text.asp?2004/20/2/176/20755



   Case Report Top


A 45-year-old male patient who underwent live related renal transplantation in 1985 for end stage renal disease due to chronic glomerulonephritis, presented with inter­mittent low grade fever of one year duration. He received various antibiotics and a short course of anti -tuberculous treatment. In the past right donor kidney was grafted in the left iliac fossa. He developed urinary leak on third post­operative day due to ureteral necrosis. An end-to-end ureteroureterostomy was performed using the native ure­ter. Postoperatively, urinary leak subsided and patient did well for 16 years.

Physical examination revealed a huge renal mass meas­uring 15 x 10 cm in the left lumbar region. Ultrasound showed a normal graft and pyonephrosis of the left native kidney. Contrast enhanced CT scan [Figure - 1] revealed dilated thinned out left native kidney and ureter extending up to the iliac vessels. Percutaneous drainage revealed about 500 ml of pus, which was positive for AFB smear and culture. Patient underwent left native nephroureterectomy. Histopathology confirmed tuberculosis. He received anti­tuberculous treatment for a period of 12 months and ad­vised INH secondary prophylaxis for life.


   Comments Top


Pyloureterostomy and ureteroureterostomy usually are done when the graft ureter blood supply appears compro­mised or there is a problem with the recipient bladder. It can be performed secondarily when there is a complication of ureteroneocystostomy as it happened in our case. The techniques of anastomoses between the graft and native ureter are either by end to side without disturbing the native ureter or end-to-end after ligating the proximal ureter.

There have been several reported cases of renal infec­tions requiring nephrectomy where the native ureter is ligated, [1] while other small studies have shown that ligating the native ureter is without morbidity. [2] However, the lat­ter studies did not have long term follow up and majority of the patients had anuria or oliguria before transplanta­tion.

We, now believe from our experience with this case that the technique using end to side anastomosis with an intact native ureter avoids any potential risk of chronically ob­structed native kidney getting infected especially when the native kidney urine output is significant.

Involvement of the native kidneys by tuberculosis in patients after renal transplantation is extremely rare. [3] A hydronephrotic, obstructed kidney is increasingly suscep­tible to infections, especially in an immunosuppressed patient and unless it is removed the infection will not re­spond to medical management alone.

 
   References Top

1.Guiter J. Cuenant E. Mourad G et al. Re-establishment of urinary continuity by ureteroureterostomy in renal transplantation. J Urol 19851; 91: 27.  Back to cited text no. 1    
2.Lord RHH, Pepera T, Williams G. Ureteroureterostomy and pyeloureterostomy without native nephrectomy in renal transplan­tation. Br J Urol 1991; 67: 349-51.  Back to cited text no. 2    
3.John GT. Shankar V, Abraham AM, Mukundan U, Thomas PP, Jacob CK. Risk factors for post-transplant tuberculosis. Kidney Interna­tional 2001: 60: 148-50.  Back to cited text no. 3    


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