Transplant kidney vesicoureteric junction calculus

Case contributed by Assoc Prof Craig Hacking

Presentation

LIF pain and dysuria. Fever and rigors.

Patient Data

Age: 65 years
Gender: Male

A 4 mm calculus (best seen on the coronals) at the vesicoureteric junction of the LIF transplant kidney is causing moderate hydroureter and hydronephrosis with perinephric stranding. No collection is identified. There is bladder wall thickening and perivesical fat stranding suggestive of inflammation of the bladder wall. No intravesical gas identified.

Bilateral atrophic native kidneys again noted. No calculus is identified in the native collecting systems or along the course of the native ureters.

Within the limits of a non-contrast study, the remainder of the abdominal viscera are unremarkable. No peritoneal free fluid or gas. The imaged lung bases are clear. No suspicious osseous lesions.

Conclusion

4 mm calculus at the vesicoureteric junction of the LIF transplant kidney is causing moderate obstruction. Contaminant cystitis and pyelonephritis.

Case Discussion

Urine MCS = E. coli

Blood cultures = negative

Background Hx of reflux nephropathy and prolonged immunosuppression.

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