Management of Stone Disease in Renal Transplant Kidneys

Abstract

Stone disease complicates nearly 1% of transplants. A calculus in a grafted kidney may develop de novo after transplantation, or pre-exist in the allograft before transplantation. Stone bearers may donate the stone-bearing kidney, if metabolic disorders and infections are excluded, the stone is solitary, less than 1.5 cm, or removable during transplantation. Transplant urolithiasis requires physicians to maintain vigilance and a high index of suspicion. The most common symptoms and signs are fever, septicemia, and impairment of renal function. These patients are best managed in centers that are well equipped and have expertise. Preferably, there should be access to a lithotripsy machine, flexible ureterorenoscopes with holmium laser, and urologists with significant experience in percutaneous nephrolithotomy. Most patients with calculi of less than 1.5 cm can be rendered stone free with shock-wave lithotripsy. If this fails, flexible ureterorenoscopy and holmium laser fragmentation may be attempted. For larger stones, percutaneous nephrolithotomy gives the best chance of complete stone clearance. © 2012 Blackwell Publishing Ltd.