title: Extracorporeal shock wave lithotripsy (ESWL) of a renal calculus in a liver transplant recipient: report of a severe complication--a case report.
abstract: BACKGROUND
  Extracorporeal shock wave lithotripsy (ESWL) has evolved as a standard treatment modality for calculi of the upper urinary tract. Noninvasive ESWL shows rare life-threatening complications. Herein we have reported the case of a liver transplant recipient who developed severe renal hemorrhage after ESWL of a renal calculus. Transfusion of erythrocytes and platelets led to anaphylactic shock with acute renal failure requiring intensive care. The patient fully recovered shortly thereafter and was discharged home with a residual left kidney stone measuring 8 mm.
  
  
  METHODS
  A 55-year-old man with a single left kidney underwent ESWL due to symptomatic left nephrolithiasis. He had undergone successful liver transplantation 11 years earlier. At the time of ESWL his liver functions were normal and his serum creatinine level was 1.3 mg/dL. Two weeks before the treatment a double pigtail ureteral stent was inserted because of a symptomatic left hydronephrosis. Several hours after ESWL treatment the patient complained of left-sided flank pain. An ultrasound revealed a large subcapsular hematoma of the left kidney, which was confirmed using abdominal computed tomography (CT). With the patient being hemodynamically stable, we opted for conservative management. Despite postinterventional complications, the patient made a fast recovery.
  
  
  CONCLUSIONS
  ESWL is a noninvasive, safe, and efficient method to treat renal calculi. Patients who are at risk for hemorrhage should undergo close postinterventional monitoring, including red blood cell count and renal ultrasound.
authors.affiliation: Department of Urology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany. frank.friedersdorff@charite.de
authors.forename: F
authors.initials: F
authors.lastname: Friedersdorff
authors.forename: J
authors.initials: J
authors.lastname: Buckendahl
authors.forename: T F
authors.initials: TF
authors.lastname: Fuller
authors.forename: H
authors.initials: H
authors.lastname: Cash
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000707:Anaphylaxis / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008096:Lithotripsy / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome