|Year : 2001 | Volume
| Issue : 2 | Page : 166-167
Renal allograft rejection causing coagulation of urine
Sanjay Gogoi, KV Sanjeevan, Anant Kumar, Aneesh Srivastava, Anil Mandhani
Department of Urology & Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Department of Urology & Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014
Source of Support: None, Conflict of Interest: None
Keywords: Rejection; Coagulation; Transplantation
|How to cite this article:|
Gogoi S, Sanjeevan K V, Kumar A, Srivastava A, Mandhani A. Renal allograft rejection causing coagulation of urine. Indian J Urol 2001;17:166-7
| Case Report|| |
A 32-year-old female renal allograft recipient developed steroid resistant acute cellular rejection six months after transplant and eventually became dialysis-dependent. 6 weeks later, she started passing fleshy material in her urine. The daily urine output was about 300 ml. Cystoscopy revealed the presence of tenacious floating material in normal looking bladder with no source of bleeding. Urine collected for examination on the next day showed an unusual picture. The urine became jelly like in 30 minutes, which eventually solidified and could not be spilled out even on inverting the test tube [Figure - 1]. This phenomenon was seen on subsequent days as well.
Urine culture yielded significant growth of staphylococcus aureus (Coagulase positive). Urine collected over 24 hours (200 ml) contained 531 mg proteins, 36 mg creatinine, 11 mg phosphorus, 10 mg calcium, 26 mmol sodium, 1.34 mmol potassium and 20 mmol of chloride. The osmolarity was 327 mosmol/L. These estimations were not done in whole urine but with the fluid collected inside the coagulum.
Urine collected from the native kidneys by selective catheterization did not clot. Attempts to measure the fibrinogen level of the urine, if any, and electrophoresis of urine did not succeed as urine samples in EDTA vials coagulated by the time it was taken for analysis to the laboratory.
Histopathology of the clot showed irregular organized proteinaceous material with entrapped mononuclear cells, straining negative for fungus and malignant cells. Graft nephrectorny was done as she was developing repeated retention of urine and was having severe hypoproteinemia. Gross appearance of the graft was unremarkable but for the presence of similar tenacious material in the ureter and renal pelvis. Histopathology of the renal graft showed features of acute rejection with tubulitis. She underwent a subsequent renal transplantation and was doing well at two-year posttransplant follow-up.
Extensive investigations of blood and urine including electrophoresis and histology of the "fleshy material ,, passed per urethra could not reveal the cause for the coagulation of urine.
| Comment|| |
High proteinuria is observed in several conditions. Perhaps the only situation in which coagulum forms in the urine is chyluria where we see an amorphous type of coagulum. Proteinuria in itself cannot lead to coagulation of urine and such an event is not reported even with nephrotic syndrome. where proteinuria may be as high as 30 to 40 g/24 hrs.  We have seen urinary protein loss of 20 - 24 g/ 24 hrs in chyluria but no similar clinical event. It could be possible that the rejected kidney was leaking fibrinogen or its degradation products. which by interacting with urinary proteins resulted in coagulation. However, we could not prove this point. We could speculate that coagulase positive staphylococci initiated or activated such a process.
| References|| |
|1.||Lafayette RA. Perrone RD, Levey AS. Laboratory evaluation of renal function. In: Schrier RW Gottschalk CW (eds.). Disease of the Kidney (6th edn.). Little Brown. Boston. 1997: 1: 307-354. |
[Figure - 1]