Post-Transplant Nephroptosis as a Cause of Recurrent Urinary Tract Infections: A Case Report

Abstract

ObjectiveThe aim of this study is to present a rare cause of recurrent urinary tract infections (UTI) in a patient after kidney transplantation. MethodsPatient's consent was obtained and full medical documentation was reviewed. After analyzing the literature, only 3 case reports of post-transplant nephroptosis were found. ResultsA 32-year-old woman with a history of type 1 diabetes, after kidney and pancreas transplantation a year earlier, was admitted to hospital due to another incident of fever, dysuria and pain of lower abdomen. Recurrent UTIs had been occurring for several months despite prophylaxis, initially with co-trimoxazole and then with fosfomycin. There were no anatomic abnormalities and tacrolimus concentrations always remained at the lower range of normal. Kinking of the ureter was suspected because of a change in the position of the transplanted kidney. Ultrasonography performed in the standing and lying position confirmed the diagnosis. A DJ catheter was inserted into the ureter. In the following months, no recurrence of UTI or urinary retention was observed. Nephroptosis of a transplanted kidney is extremely rare. The standard place for graft implantation - the iliac fossa - significantly limits the potential for migration. Kidneys implanted intraperitoneally also do not show clinically significant mobility due to postoperative adhesions. Floating kidney potentially leads to serious complications. In addition to pain, a migrating graft may cause urine retention, predisposing to UTI and acute kidney injury. ConclusionsNephroptosis of transplanted kidney is extremely rare, therefore the diagnosis is not always obvious, which may result in treatment delay.