Spontaneous Renal Allograft Rupture Caused by Acute Tubular Necrosis: A Case Report and Review of the Literature.

Deepak Shankar Ray,Sharmila Thukral

doi:10.1155/2017/9158237

Abstract

Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. RAR is frequently associated with acute rejection, but other causes like renal vein thrombosis and acute tubular necrosis have also been observed. Most commonly a graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. Herein, we describe a rare case of spontaneous renal allograft rupture in the early posttransplant period due to acute tubular necrosis. A 42-year-old male, living donor renal allograft recipient, experienced RAR on the sixth posttransplant day. Surgical exploration showed two lacerations of 10 cm and 5 cm length at the upper and mid pole of the kidney. Histologically, the graft demonstrated acute tubular injury; no features of humoral or cellular rejection were identified. The successful management of this complication resulted in the salvage of the patient and the graft. This case demonstrates that early diagnosis and prompt treatment of a life-threatening RAR can salvage the graft.

Highlights

Spontaneous renal allograft rupture is a rare yet potentially life-threatening complication of renal transplantation
We report an unusual case of a renal allograft recipient who developed a spontaneous Renal allograft rupture (RAR)
Other factors contributing to RAR include ischaemic acute kidney injury, acute tubular necrosis, damaged hilar lymphatic channels, renal vein thrombosis, ureteral obstruction with subsequent hydronephrosis, renal biopsy, trauma, nephrostomy tubes, and development of renal cell cancer [4, 5, 9,10,11]

Summary

Introduction

Spontaneous renal allograft rupture is a rare yet potentially life-threatening complication of renal transplantation. It is associated with a high incidence of graft loss [1]. The consequences are fatal in 6% of the cases and graft loss is the outcome in another 53% [2]. Most of these cases are immunologically mediated and caused by acute rejection. The graft was successfully salvaged by surgical repair This case emphasises that the transplant team must be aware of this fatal complication and the current management strategies

Case History

Discussion

Findings

Conclusion