title: [Renal allograft rupture attributed to coughing while asleep: a case report].
abstract: Renal allograft rupture (RAR) is a rare but serious complication of renal transplantation. The most common cause of RAR is acute rejection but other causes have increased in frequency with advances in immunosuppressive therapy. We report a patient with RAR attributed to coughing while asleep. A 53-year-old male received a living-donor renal transplantation for end-stage renal failure due to diabetic nephropathy. The clinical course was satisfactory, and he was discharged on the 12th postoperative day with a serum creatinine level of 1.24 mg/dl. On the 24th morning, he felt sudden swelling and pain over the incision area soon after a big cough. Ultrasound and computed tomography revealed a perinephric hematoma. Emergency surgical exploration showed complete laceration of the abdominal fascia and 4-cm rupture at the anterolateral aspect of the kidney. High intra-abdominal pressure when coughing had torn the fascia, and the graft appeared to have ruptured under the fascial tension. Bleeding was controlled with a polyglactin 910 2/0 mattress parenchymal suture enforced with application of a fibrin tissue-adhesive collagen fleece. Twelve months after the repair, the patient's renal function was stable with a serum creatinine level of 1.3 mg/dl.
authors.affiliation: The Department of Urology, Tokyo Women's Medical University.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shiraishi
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Taro
authors.initials: T
authors.lastname: Wakamatsu
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yanishi
authors.forename: Eri
authors.initials: E
authors.lastname: Tomita
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shirakawa
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Shimizu
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishida
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D003371:Cough / Q000150:complications*; D006801:Humans; D007668:Kidney / Q000293:injuries*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012421:Rupture; D012890:Sleep / Q000502:physiology*; D014184:Transplantation, Homologous