A veno-caliceal fistula related to ureteric stricture in a kidney allograft masquerading as renal failure.
We report an unusual case of veno-caliceal fistula that developed because of high ureteric pressure caused by graft ureteric stricture after kidney transplantation in a 60-year-old patient. We further confirmed its presence with radiological images. Recirculation of creatinine and other uremic toxins resulted in a biochemical picture of renal failure in the presence of normal kidney function, confirmed by normal scintigraphy findings. Drainage of the pelvi-caliceal system could not be assessed accurately by means of diuretic renogram using technetium-99m diethylenetriaminepentaacetic acid with frusemide because of the rapid clearance of tracer activity from the system in the presence of a veno-caliceal fistula. The patient's renal function improved rapidly after interrupting urine recirculation by using percutaneous drainage, confirming "pseudo renal failure" as the cause of his persistently increased serum creatinine concentration. The ureter was re-implanted later, and the veno-caliceal fistula was not seen in the nephrostogram after the operation. He remains well with stable renal function at 3 years' follow-up. Clinicians should exercise judgment when evaluating patients with allograft dysfunction, especially when the investigation and clinical findings show contradicting results.
Chan
Yiu-Han
YH
Department of Medicine, Renal Unit, Queen Elizabeth Hospital, Hong Kong, SAR. chanyhj@ha.org.hk
Wong
Kim Ming
KM
Kwok
Philip Chong-Hei
PC
Liu
Allen Yan-Lun
AY
Choi
Koon Shing
KS
Chau
Ka Foon
KF
Li
Chun Sang
CS
D003287:Contrast Media; D003937:Diagnosis, Differential; D004232:Diuretics; D005188:False Negative Reactions; D005665:Furosemide; D006801:Humans; D007670:Kidney Calices; D007674:Kidney Diseases / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D019275:Radiopharmaceuticals; D051437:Renal Insufficiency / Q000175:diagnosis*; D012082:Renal Veins; D016284:Technetium Tc 99m Pentetate; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D014517:Ureteral Obstruction / Q000150:complications / Q000209:etiology*; D014548:Urinary Fistula / Q000175:diagnosis* / Q000209:etiology*
D003287:Contrast Media; D004232:Diuretics; D019275:Radiopharmaceuticals; D005665:Furosemide; D016284:Technetium Tc 99m Pentetate