Delayed calyceal cutaneous fistula after renal transplantation

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Calyceal cutaneous fistula is a serious complication of renal transplantation. It is usually caused by segmental renal infarction resulting from an unrecognized ligated or severed accessory renal vessel during donor nephrectomy. Unless associated with trauma, a calyceal fistula usually develops within the first 3 months of transplantation. This is the first reported case of a calyceal cutaneous fistula in a renal transplant patient manifested 2 years after renal transplantation and associated with acute pyelonephritis and apparently newly developed amyloidosis. Prompt surgical intervention with primary closure of the fistula achieved a successful outcome.

Urinary extravasation is a perplexing problem of renal transplantation; its incidence varies between 8% and 17%.1, 2 Although oliguria is a common finding in most of the cases, the initial diagnosis is usually unrecognized because of concomitant rejection or infection or both.3 We report a case of calyceal cutaneous fistula in a renal transplant patient with presenting symptoms of acute pyelonephritis.

Case report

A 51-year-old Caucasian man whose original renal disease was focal sclerosing glomerulonephritis received a second renal allograft. A Terasaki “C” matched renal allograft donated by a sibling had been rejected after 41 months of good function. The second renal allograft, from a cadaver donor, matched for only HLA antigen functioned immediately. By the 15th day the serum creatinine was 1.8 mg/dl.

The patient did well until 23 months later when he was admitted because of fever, chills, and pain over the allograft. Both urine and blood cultures grew Escherichia coli and his serum creatinine level . . .



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