Case Report
A Veno-Caliceal Fistula Related to Ureteric Stricture in a Kidney Allograft Masquerading as Renal Failure

https://doi.org/10.1053/j.ajkd.2007.01.010Get rights and content

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.

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Case Report

The patient was a 60-year-old man with end-stage renal failure caused by diabetic nephropathy. He underwent cadaveric kidney transplantation in 2003 in another center after receiving a short period of temporary hemodialysis support. Details of the operation were not available. His maintenance immunosuppressive regimen consisted of cyclosporine A, mycophenolate mofetil, and prednisolone. The kidney graft had immediate function, and serum creatinine level decreased to 2.1 mg/dL (160 μmol/L) at 3

Discussion

Veno-caliceal fistula related to ureteric obstruction is a rare complication of renal transplantation, and to the best of our knowledge, we are the first group to show the presence of a veno-caliceal fistula in a renal allograft by means of radiological images.

A renal backflow phenomenon was observed in patients with acute ureteral obstruction when the kidney resorbs urine as a compensatory mechanism to allow continued excretion.1 The pyelovenous backflow phenomenon sometimes can be seen on

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Cited by (5)

  • Calyceal-venous fistula of the kidney: A rare case report and review of literature

    2019, Urology Case Reports
    Citation Excerpt :

    A fatality has been reported from calyceal-venous fistula secondary to urosepsis following percutaneous nephrolithotomy.4 This could possibly be explained due to systemic circulation of toxins and bacteria via the calyceal-venous fistula as described by Chan et al.5 In summary, we believe that this is an exceptionally rare surgical complication.

Originally published online as doi:10.1053/j.ajkd.2007.01.010 on February 22, 2007.

Support: None. Potential conflicts of interest: None.

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