|Year : 2004 | Volume
| Issue : 2 | Page : 176-177
Tuberculous pyonephrosis of native kidney in a transplant recipient 16 years after the ligation of the native ureter
PVLN Murthy, Surya Prakash, Nandkumar, Ram Reddy, KV Dakshina Murthy
Department of Urology and Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
Department of Urology, Nizam's Institute of Medical Sciences, Hyderabad - 500 082
Source of Support: None, Conflict of Interest: None
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 Nov 13];20:176-7. Available from: http://www.indianjurol.com/text.asp?2004/20/2/176/20755
| Case Report|| |
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|| |
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,  while other small studies have shown that ligating the native ureter is without morbidity.  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.  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|| |
|1.||Guiter J. Cuenant E. Mourad G et al. Re-establishment of urinary continuity by ureteroureterostomy in renal transplantation. J Urol 19851; 91: 27. |
|2.||Lord RHH, Pepera T, Williams G. Ureteroureterostomy and pyeloureterostomy without native nephrectomy in renal transplantation. Br J Urol 1991; 67: 349-51. |
|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. |
[Figure - 1]