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Successful management of repetitive urinary obstruction and anuria caused by double j stent calculi formation after renal transplantation.

Hao Z, Zhang L, Zhou J, Zhang X, Shi H, Zhang Y, Wei P, Liang C - Case Rep Transplant (2014)

Bottom Line: She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements.Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3) administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease.After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology, Anhui Medical University, Hefei, Anhui 230022, China.

ABSTRACT
This report firstly describes an extremely rare case of repetitive double J stent calculi formation after renal transplantation caused by the antihyperparathyroidism (HPT) drug calcitriol. In 2012, a woman initially presented to our hospital for anuria with lower abdominal pain. She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements. Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3) administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease. After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up. Our novel findings may provide an important clue and approach to managing formidable repetitive double J stent calculi formation in the clinical trial.

No MeSH data available.


Related in: MedlinePlus

Calculi formation in the completely blocked double J stent. (a) Overview of the modified double J stent obtained from the patient's pelvic cavity. (b) Enlarged image of the double J stent: typical calculi were indicated with the red arrows. (c) Completed blockage of the double J stent by the calculi: typical calculi were indicated with the red dashed lines.
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fig2: Calculi formation in the completely blocked double J stent. (a) Overview of the modified double J stent obtained from the patient's pelvic cavity. (b) Enlarged image of the double J stent: typical calculi were indicated with the red arrows. (c) Completed blockage of the double J stent by the calculi: typical calculi were indicated with the red dashed lines.

Mentions: After viewing the medical history, we began to make a physical examination for her. She had unremarkable physical signs except for a suffering moon face and slight abdominal bulge and pain. Routine blood investigation file revealed red blood cells, white blood cells, and platelet counts of 4.11 × 1012/L, 10.38 × 109/L, and 322 × 109/L, respectively. Besides, the following data were obtained: total protein, 54.8 g/L; albumin, 29.0 g/L; glucose, 4.69 mmol/L; urea nitrogen, 2.84 mmol/L; creatinine, 61 μmol/L; potassium, 3.30 mmol/L; sodium, 135.5 mmol/L; chlorinum, 103.1 mmol/L; magnesium, 0.63 mmol/L; phosphonium, 1.00 mmol/L; intact PTH, 32.1 pg/mL; 24-hour urine calcium, 4.42 mmol/L; and calcium, 2.19 mmol/L. For the imaging diagnosis, type-B ultrasound revealed moderate hydronephrosis of the transplanted kidney in the right lateral of pelvic cavity. Kidney-ureter-bladder (KUB) radiography clearly showed the stent modified by cutting a length of 9 cm from one end of the classical 25 cm full-length double J ureteral stent to improve its clinical acceptability (as the donor kidney is usually placed in a lower position in the pelvic cavity) (Figure 1, red arrows, and Figure 2(a)). After careful and detailed examinations, we conducted the operation to substitute a new Bard-InLay internal 6F double J stent for the originally blocked one. Subsequently, infrared spectrum analysis elucidated that the calculi in the completely blocked stent consisted of whewellite, weddellite, and carbonated apatite (Figures 2(b) and 2(c), red arrows and dashed lines). The patient's urine volume reached 4300 mL the next whole day after operation. Besides, her kidney function tests and multiple urine cytologies were absolutely normal. After discontinuing calcitriol, the patient was found to be calculi-free and the 9-month follow-up showed a good recovery without stent obstruction or anuria with lower abdominal pain, which she had been confronting several times before receiving the appropriate management in our hospital.


Successful management of repetitive urinary obstruction and anuria caused by double j stent calculi formation after renal transplantation.

Hao Z, Zhang L, Zhou J, Zhang X, Shi H, Zhang Y, Wei P, Liang C - Case Rep Transplant (2014)

Calculi formation in the completely blocked double J stent. (a) Overview of the modified double J stent obtained from the patient's pelvic cavity. (b) Enlarged image of the double J stent: typical calculi were indicated with the red arrows. (c) Completed blockage of the double J stent by the calculi: typical calculi were indicated with the red dashed lines.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4109115&req=5

fig2: Calculi formation in the completely blocked double J stent. (a) Overview of the modified double J stent obtained from the patient's pelvic cavity. (b) Enlarged image of the double J stent: typical calculi were indicated with the red arrows. (c) Completed blockage of the double J stent by the calculi: typical calculi were indicated with the red dashed lines.
Mentions: After viewing the medical history, we began to make a physical examination for her. She had unremarkable physical signs except for a suffering moon face and slight abdominal bulge and pain. Routine blood investigation file revealed red blood cells, white blood cells, and platelet counts of 4.11 × 1012/L, 10.38 × 109/L, and 322 × 109/L, respectively. Besides, the following data were obtained: total protein, 54.8 g/L; albumin, 29.0 g/L; glucose, 4.69 mmol/L; urea nitrogen, 2.84 mmol/L; creatinine, 61 μmol/L; potassium, 3.30 mmol/L; sodium, 135.5 mmol/L; chlorinum, 103.1 mmol/L; magnesium, 0.63 mmol/L; phosphonium, 1.00 mmol/L; intact PTH, 32.1 pg/mL; 24-hour urine calcium, 4.42 mmol/L; and calcium, 2.19 mmol/L. For the imaging diagnosis, type-B ultrasound revealed moderate hydronephrosis of the transplanted kidney in the right lateral of pelvic cavity. Kidney-ureter-bladder (KUB) radiography clearly showed the stent modified by cutting a length of 9 cm from one end of the classical 25 cm full-length double J ureteral stent to improve its clinical acceptability (as the donor kidney is usually placed in a lower position in the pelvic cavity) (Figure 1, red arrows, and Figure 2(a)). After careful and detailed examinations, we conducted the operation to substitute a new Bard-InLay internal 6F double J stent for the originally blocked one. Subsequently, infrared spectrum analysis elucidated that the calculi in the completely blocked stent consisted of whewellite, weddellite, and carbonated apatite (Figures 2(b) and 2(c), red arrows and dashed lines). The patient's urine volume reached 4300 mL the next whole day after operation. Besides, her kidney function tests and multiple urine cytologies were absolutely normal. After discontinuing calcitriol, the patient was found to be calculi-free and the 9-month follow-up showed a good recovery without stent obstruction or anuria with lower abdominal pain, which she had been confronting several times before receiving the appropriate management in our hospital.

Bottom Line: She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements.Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3) administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease.After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology, Anhui Medical University, Hefei, Anhui 230022, China.

ABSTRACT
This report firstly describes an extremely rare case of repetitive double J stent calculi formation after renal transplantation caused by the antihyperparathyroidism (HPT) drug calcitriol. In 2012, a woman initially presented to our hospital for anuria with lower abdominal pain. She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements. Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3) administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease. After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up. Our novel findings may provide an important clue and approach to managing formidable repetitive double J stent calculi formation in the clinical trial.

No MeSH data available.


Related in: MedlinePlus