Journal List > Ewha Med J > v.38(3) > 1058630

TOOLS
Na, Kong, Lee, Kim, Jang, Kim, and Lee: Hypocitraturia-related Ureteral Steinstrasse in a Renal Transplant Recipient
Case Report

The Ewha Medical Journal 2015; 38(3): 117-120.

Published online: 31 October 2015

DOI: https://doi.org/10.12771/emj.2015.38.3.117

Hypocitraturia-related Ureteral Steinstrasse in a Renal Transplant Recipient

Jeong Gu Na, Sung Min Kong, Dong Gyu Lee, Seong Min Kim, Yoonjung Jang, Sung Rok Kim, Yu-Ji Lee

Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Corresponding author: Yu-Ji Lee. Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon 51353, Korea. Tel: 82-55-290-6332, Fax: 82-55-290-1064, yuji.lee@samsung.com

Received 16 May 2015       Accepted 20 August 2015

Copyright © 2015, The Ewha Medical Journal

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Citric acid, Renal transplantation, Ureter, Stones

Figures and Tables

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).

emj-38-117-g001
Fig. 2

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

emj-38-117-g002
Table 1

Result of Stone analysis

emj-38-117-i001

References

1. Mamarelis G, Vernadakis S, Moris D, Altanis N, Perdikouli M, Stravodimos K, et al. Lithiasis of the renal allograft, a rare urological complication following renal transplantation: a single-center experience of 2,045 renal transplantations. Transplant Proc. 2014; 46:3203–3205.
2. Ferreira Cassini M, Cologna AJ, Ferreira Andrade M, Lima GJ, Medeiros Albuquerque U, Pereira Martins AC, et al. Lithiasis in 1,313 kidney transplants: incidence, diagnosis, and management. Transplant Proc. 2012; 44:2373–2375.
3. Kim H, Cheigh JS, Ham HW. Urinary stones following renal transplantation. Korean J Intern Med. 2001; 16:118–122.
4. Verrier C, Bessede T, Hajj P, Aoubid L, Eschwege P, Benoit G. Decrease in and management of urolithiasis after kidney transplantation. J Urol. 2012; 187:1651–1655.
5. Salem S, Mehrsai A, Zartab H, Shahdadi N, Pourmand G. Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients. Urol Res. 2010; 38:135–142.
6. Harper JM, Samuell CT, Hallson PC, Wood SM, Mansell MA. Risk factors for calculus formation in patients with renal transplants. Br J Urol. 1994; 74:147–150.
7. Stapenhorst L, Sassen R, Beck B, Laube N, Hesse A, Hoppe B. Hypocitraturia as a risk factor for nephrocalcinosis after kidney transplantation. Pediatr Nephrol. 2005; 20:652–656.
8. Hamm LL, Hering-Smith KS. Pathophysiology of hypocitraturic nephrolithiasis. Endocrinol Metab Clin North Am. 2002; 31:885–893.
9. Hamm LL. Renal handling of citrate. Kidney Int. 1990; 38:728–735.
10. Simpson DP. Citrate excretion: a window on renal metabolism. Am J Physiol. 1983; 244:F223–F234.
11. Cicerello E, Merlo F, Mangano M, Cova G, Maccatrozzo L. Urolithiasis in renal transplantation: diagnosis and management. Arch Ital Urol Androl. 2014; 86:257–260.
12. Homayoon K. Spontaneous steinstrasse due to renal tubular acidosis. Br J Urol. 1996; 77:610–611.
13. Van Savage JG, Fried FA. Bilateral spontaneous steinstrasse and nephrocalcinosi associated with distal renal tubular acidosis. J Urol. 1993; 150(2 Pt 1):467–468.
14. Stravodimos KG, Adamis S, Tyritzis S, Georgios Z, Constantinides CA. Renal transplant lithiasis: analysis of our series and review of the literature. J Endourol. 2012; 26:38–44.
TOOLS
Similar articles