Skip to main content
Top
Published in: BMC Urology 1/2015

Open Access 01-12-2015 | Case report

Spontaneous renal allograft rupture complicated by urinary leakage: case report and review of the literature

Authors: Evaldo Favi, Samuele Iesari, Alessandro Cina, Franco Citterio

Published in: BMC Urology | Issue 1/2015

Login to get access

Abstract

Background

For more than forty years, graftectomy has been the standard treatment of spontaneous renal transplant rupture. However, recent evidences suggest that graft salvage strategies can be safely pursued, even in difficult cases.

Case presentation

We report on a thirty-nine-year-old woman who received a deceased donor kidney transplant and experienced spontaneous allograft rupture due to acute rejection. The rupture was further complicated by urinary leakage. The kidney and the ureter were successfully repaired. Eight years after transplantation, graft function is still excellent.

Conclusion

Due to the lack of transplantable organs and the long time usually spent on the waiting list, graftectomy should be only considered in case of refractory haemodynamic instability or compromised graft viability.
Literature
1.
go back to reference Richardson AJ, Higgins RM, Jaskowski AJ, Murie JA, Dunnill MS, Ting A, et al. Spontaneous rupture of renal allografts: the importance of renal vein thrombosis in the cyclosporine era. Br J Surg. 1991;77:558–60.CrossRef Richardson AJ, Higgins RM, Jaskowski AJ, Murie JA, Dunnill MS, Ting A, et al. Spontaneous rupture of renal allografts: the importance of renal vein thrombosis in the cyclosporine era. Br J Surg. 1991;77:558–60.CrossRef
2.
go back to reference Hochleitner BW, Kafka R, Spechtenhauser B, Bösmüller C, Steurer W, Königsrainer A, et al. Renal allograft rupture is associated with rejection or acute tubular necrosis, but not with renal vein thrombosis. Nephrol Dial Transplant. 2001;16:124–7.CrossRefPubMed Hochleitner BW, Kafka R, Spechtenhauser B, Bösmüller C, Steurer W, Königsrainer A, et al. Renal allograft rupture is associated with rejection or acute tubular necrosis, but not with renal vein thrombosis. Nephrol Dial Transplant. 2001;16:124–7.CrossRefPubMed
3.
go back to reference Azar GJ, Zarifian A, Frentz GD, Tesi RJ, Etheredge EE. Renal allograft rupture: a clinical review. Clin Transplant. 1996;10:635–8.PubMed Azar GJ, Zarifian A, Frentz GD, Tesi RJ, Etheredge EE. Renal allograft rupture: a clinical review. Clin Transplant. 1996;10:635–8.PubMed
4.
go back to reference Heimbach D, Miersch WD, Buszello H, Schoeneich G, Kleht HU. Is the transplant-preserving management of renal allograft rupture justified? Br J Urol. 1995;75:729–32.CrossRefPubMed Heimbach D, Miersch WD, Buszello H, Schoeneich G, Kleht HU. Is the transplant-preserving management of renal allograft rupture justified? Br J Urol. 1995;75:729–32.CrossRefPubMed
5.
go back to reference Finley DS, Roberts JP. Frequent salvage of ruptured renal allografts: a large single center experience. Clin Transplant. 2003;17:126–9.CrossRefPubMed Finley DS, Roberts JP. Frequent salvage of ruptured renal allografts: a large single center experience. Clin Transplant. 2003;17:126–9.CrossRefPubMed
6.
go back to reference Chan YH, Wong KM, Lee KC, Li CS. Spontaneous renal allograft rupture attributed to acute tubular necrosis. Am J Kidney Dis. 1999;34:355–8.CrossRefPubMed Chan YH, Wong KM, Lee KC, Li CS. Spontaneous renal allograft rupture attributed to acute tubular necrosis. Am J Kidney Dis. 1999;34:355–8.CrossRefPubMed
7.
go back to reference Szenohradszky P, Smehak G, Szederkenyi E, Marofka F, Csajbok E, Morvay Z, et al. Renal allograft rupture: a clinicopathologic study of 37 nephrectomy cases in a series of 628 consecutive renal transplants. Transplant Proc. 1999;31:2107–11.CrossRefPubMed Szenohradszky P, Smehak G, Szederkenyi E, Marofka F, Csajbok E, Morvay Z, et al. Renal allograft rupture: a clinicopathologic study of 37 nephrectomy cases in a series of 628 consecutive renal transplants. Transplant Proc. 1999;31:2107–11.CrossRefPubMed
8.
go back to reference Soler R, Perez-Fontan FJ, Lago M, Moncalian J, Perez-Fontan M. Renal allograft rupture: diagnostic role of ultrasound. Nephrol Dial Transplant. 1992;7:871–4.PubMed Soler R, Perez-Fontan FJ, Lago M, Moncalian J, Perez-Fontan M. Renal allograft rupture: diagnostic role of ultrasound. Nephrol Dial Transplant. 1992;7:871–4.PubMed
9.
go back to reference Hanke P, Fassbinder W, Brox G. Treatment of spontaneous kidney allograft rupture by means of fibrin sealant and collagen fleece: experimental and clinical studies. Transplant Proc. 1986;18:1029–33. Hanke P, Fassbinder W, Brox G. Treatment of spontaneous kidney allograft rupture by means of fibrin sealant and collagen fleece: experimental and clinical studies. Transplant Proc. 1986;18:1029–33.
10.
go back to reference Said R, Duarte R, Chaballout A, Boghdadly SE, Nezamuddin N, Mattoo T. Spontaneous rupture of renal allograft. Urology. 1994;43:554–5.CrossRefPubMed Said R, Duarte R, Chaballout A, Boghdadly SE, Nezamuddin N, Mattoo T. Spontaneous rupture of renal allograft. Urology. 1994;43:554–5.CrossRefPubMed
11.
go back to reference Murray JE, Wilson RE, Tilney NL, Merrill JP, Cooper WC, Birtch AG, et al. Five years' experience in renal transplantation with immunosuppressive drugs: survival, function, complications, and the role of lymphocyte depletion by thoracic duct fistula. Ann Surg. 1968;168:416–35.CrossRefPubMedPubMedCentral Murray JE, Wilson RE, Tilney NL, Merrill JP, Cooper WC, Birtch AG, et al. Five years' experience in renal transplantation with immunosuppressive drugs: survival, function, complications, and the role of lymphocyte depletion by thoracic duct fistula. Ann Surg. 1968;168:416–35.CrossRefPubMedPubMedCentral
12.
go back to reference Salaman JR, Calne RY, Pena J, Sells RA, White HJ, Yoffa D. Surgical aspects of clinical renal transplantation. Br J Surg. 1969;56:413–7.CrossRefPubMed Salaman JR, Calne RY, Pena J, Sells RA, White HJ, Yoffa D. Surgical aspects of clinical renal transplantation. Br J Surg. 1969;56:413–7.CrossRefPubMed
13.
go back to reference Siedek M. Observations in rejections of kidney transplants. Langenbecks Arch Surg. 1969;325:714–9.CrossRef Siedek M. Observations in rejections of kidney transplants. Langenbecks Arch Surg. 1969;325:714–9.CrossRef
14.
go back to reference Flanigan WJ, Caldwell FT, Williams GD, Brewer TE, Glenn WE, Headstream JW, et al. Clinical patterns of renal allograft rejection. Ann Surg. 1971;173:733–47.CrossRefPubMedPubMedCentral Flanigan WJ, Caldwell FT, Williams GD, Brewer TE, Glenn WE, Headstream JW, et al. Clinical patterns of renal allograft rejection. Ann Surg. 1971;173:733–47.CrossRefPubMedPubMedCentral
15.
go back to reference Haimov M, Glabman S, Burrows L. Spontaneous rupture of the allografted kidney. Arch Surg. 1971;103:510–2.CrossRefPubMed Haimov M, Glabman S, Burrows L. Spontaneous rupture of the allografted kidney. Arch Surg. 1971;103:510–2.CrossRefPubMed
17.
go back to reference Minale C, Linder E, Largiader F. Spontaneous rupture of a transplanted kidney. Dtsch Med Wochenschr. 1972;97:459–61.CrossRefPubMed Minale C, Linder E, Largiader F. Spontaneous rupture of a transplanted kidney. Dtsch Med Wochenschr. 1972;97:459–61.CrossRefPubMed
18.
go back to reference Ghose MK, Kest LM, Cohen SM, Roza O, Berman LB, Lidsky I, et al. Spontaneous rupture of renal allotransplants. J Urol. 1973;109:790–5.PubMed Ghose MK, Kest LM, Cohen SM, Roza O, Berman LB, Lidsky I, et al. Spontaneous rupture of renal allotransplants. J Urol. 1973;109:790–5.PubMed
19.
20.
go back to reference Kootstra G, Meijer S, Elema JD. "Spontaneous" rupture of homografted kidneys. Arch Surg. 1974;108:107–12.CrossRefPubMed Kootstra G, Meijer S, Elema JD. "Spontaneous" rupture of homografted kidneys. Arch Surg. 1974;108:107–12.CrossRefPubMed
21.
go back to reference Homan WP, Cheigh JS, Kim SJ, Mouradian J, Tapia L, Riggio RR, et al. Renal allograft fracture: clinicopathological study of 21 cases. Ann Surg. 1977;186:700–3.CrossRefPubMedPubMedCentral Homan WP, Cheigh JS, Kim SJ, Mouradian J, Tapia L, Riggio RR, et al. Renal allograft fracture: clinicopathological study of 21 cases. Ann Surg. 1977;186:700–3.CrossRefPubMedPubMedCentral
22.
23.
go back to reference Brekke I, Flatmark A, Laane B, Mellbye O. Renal allograft rupture. Scand J Urol Nephrol. 1978;12:265–70.CrossRefPubMed Brekke I, Flatmark A, Laane B, Mellbye O. Renal allograft rupture. Scand J Urol Nephrol. 1978;12:265–70.CrossRefPubMed
24.
go back to reference Montes F, McMaster P, Calne RY, Evans DB. Rupture of the allografted kidney--is repair possible? Proc Eur Dial Transplant Assoc. 1978;15:378–83.PubMed Montes F, McMaster P, Calne RY, Evans DB. Rupture of the allografted kidney--is repair possible? Proc Eur Dial Transplant Assoc. 1978;15:378–83.PubMed
25.
go back to reference Susan LP, Braun WE, Banowsky LH, Straffon RA, Valenzuela R. Ruptured human renal allograft. Pathogenesis and management Urology. 1978;11:53–7.PubMed Susan LP, Braun WE, Banowsky LH, Straffon RA, Valenzuela R. Ruptured human renal allograft. Pathogenesis and management Urology. 1978;11:53–7.PubMed
26.
27.
go back to reference Prompt CA, Johnson WH, Ehrlich RM, Lee DB, Smith RB, Schultze RG. Nontraumatic rupture of renal allografts. Urology. 1979;13:145–8.CrossRefPubMed Prompt CA, Johnson WH, Ehrlich RM, Lee DB, Smith RB, Schultze RG. Nontraumatic rupture of renal allografts. Urology. 1979;13:145–8.CrossRefPubMed
28.
go back to reference Oesterwitz H, Tulatz A, Scholz D, May G. Spontaneous rupture of cadaver kidney allotransplants: how successful is a repair? Report of 22 cases and review of the literature. Eur Urol. 1980;6:284–8.PubMed Oesterwitz H, Tulatz A, Scholz D, May G. Spontaneous rupture of cadaver kidney allotransplants: how successful is a repair? Report of 22 cases and review of the literature. Eur Urol. 1980;6:284–8.PubMed
29.
go back to reference van der Vliet JA, Kootstra G, Tegzess AM, Meijer S, Krom RA, Slooff MJ, et al. Management of rupture in allografted kidneys. Neth J Surg. 1980;32:45–8.PubMed van der Vliet JA, Kootstra G, Tegzess AM, Meijer S, Krom RA, Slooff MJ, et al. Management of rupture in allografted kidneys. Neth J Surg. 1980;32:45–8.PubMed
30.
go back to reference Goldman M, De Pauw L, Kinnaert P, Vereerstraeten P, Van Geertruyden J, Toussaint C. Renal allograft rupture: possible causes and results of surgical conservative management. Transplantation. 1981;32:153–6.CrossRefPubMed Goldman M, De Pauw L, Kinnaert P, Vereerstraeten P, Van Geertruyden J, Toussaint C. Renal allograft rupture: possible causes and results of surgical conservative management. Transplantation. 1981;32:153–6.CrossRefPubMed
31.
go back to reference Nghiem DD, Goldman MH, Mendez-Picon G, Rao KG, Woodlief RM, Fields WR, et al. Noninvasive assessment of the transplanted kidney: ultrasound vs. computerized tomography. Am Surg. 1981;47:492–4.PubMed Nghiem DD, Goldman MH, Mendez-Picon G, Rao KG, Woodlief RM, Fields WR, et al. Noninvasive assessment of the transplanted kidney: ultrasound vs. computerized tomography. Am Surg. 1981;47:492–4.PubMed
32.
go back to reference Thukral R, Mir AR, Jacobson MP. Renal allograft rupture: a report of three cases and review of the literature. Am J Nephrol. 1982;2:15–27.CrossRefPubMed Thukral R, Mir AR, Jacobson MP. Renal allograft rupture: a report of three cases and review of the literature. Am J Nephrol. 1982;2:15–27.CrossRefPubMed
33.
go back to reference Serrallach N, Gutierrez R, Serrate R, Aguilo F, Munoz J, Franco E, et al. Renal allograft rupture: surgical treatment by renal corsetage with lyophilized human dura. J Urol. 1985;133:452–5.PubMed Serrallach N, Gutierrez R, Serrate R, Aguilo F, Munoz J, Franco E, et al. Renal allograft rupture: surgical treatment by renal corsetage with lyophilized human dura. J Urol. 1985;133:452–5.PubMed
34.
go back to reference Chopin DK, Abbou CC, Lottmann HB, Popov Z, Lang PR, Buisson CL, et al. Conservative treatment of renal allograft rupture with polyglactin 910 mesh and gelatin resorcin formaldehyde glue. J Urol. 1989;142:363–5.PubMed Chopin DK, Abbou CC, Lottmann HB, Popov Z, Lang PR, Buisson CL, et al. Conservative treatment of renal allograft rupture with polyglactin 910 mesh and gelatin resorcin formaldehyde glue. J Urol. 1989;142:363–5.PubMed
35.
go back to reference Yadav RV, Sinha R. Graft repair: the treatment of choice for renal allograft rupture. J Urol. 1994;151:1498–9.PubMed Yadav RV, Sinha R. Graft repair: the treatment of choice for renal allograft rupture. J Urol. 1994;151:1498–9.PubMed
36.
go back to reference Zadrozny D, Pirski MI, Draczkowski T, Gacyk W. The treatment of renal allograft rupture. Transplant Proc. 1997;29:156.CrossRefPubMed Zadrozny D, Pirski MI, Draczkowski T, Gacyk W. The treatment of renal allograft rupture. Transplant Proc. 1997;29:156.CrossRefPubMed
37.
go back to reference Pontones Moreno JL, Rodrigo Aliaga M, Monserrat Monfort JJ, Guillen Navarro M, Sanchez Plumed J, Jimenez Cruz JF. Post-transplantation renal rupture. Actas Urol Esp. 1998;22:840–5. discussion 6.PubMed Pontones Moreno JL, Rodrigo Aliaga M, Monserrat Monfort JJ, Guillen Navarro M, Sanchez Plumed J, Jimenez Cruz JF. Post-transplantation renal rupture. Actas Urol Esp. 1998;22:840–5. discussion 6.PubMed
38.
go back to reference Millwala FN, Abraham G, Shroff S, Soundarajan P, Rao R, Kuruvilla S. Spontaneous renal allograft rupture in a cohort of renal transplant recipients: a tertiary care experience. Transplant Proc. 2000;32:1912–3.CrossRefPubMed Millwala FN, Abraham G, Shroff S, Soundarajan P, Rao R, Kuruvilla S. Spontaneous renal allograft rupture in a cohort of renal transplant recipients: a tertiary care experience. Transplant Proc. 2000;32:1912–3.CrossRefPubMed
39.
go back to reference Ramos M, Martins L, Dias L, Henriques AC, Soares J, Queiros J, et al. Renal allograft rupture: a clinicopathologic review. Transplant Proc. 2000;32:2597–8.CrossRefPubMed Ramos M, Martins L, Dias L, Henriques AC, Soares J, Queiros J, et al. Renal allograft rupture: a clinicopathologic review. Transplant Proc. 2000;32:2597–8.CrossRefPubMed
40.
go back to reference Guleria S, Khazanchi RK, Dinda AK, Aggarwal S, Gupta S, Bhowmik D, et al. Spontaneous renal allograft rupture: is graft nephrectomy an option? Transplant Proc. 2003;35:339.CrossRefPubMed Guleria S, Khazanchi RK, Dinda AK, Aggarwal S, Gupta S, Bhowmik D, et al. Spontaneous renal allograft rupture: is graft nephrectomy an option? Transplant Proc. 2003;35:339.CrossRefPubMed
41.
go back to reference He B, Rao MM, Han X, Li X, Guan D, Gao J. Surgical repair of spontaneous renal allograft rupture: a new procedure. ANZ J Surg. 2003;73:381–3.CrossRefPubMed He B, Rao MM, Han X, Li X, Guan D, Gao J. Surgical repair of spontaneous renal allograft rupture: a new procedure. ANZ J Surg. 2003;73:381–3.CrossRefPubMed
42.
go back to reference Busi N, Capocasale E, Mazzoni MP, Benozzi L, Valle RD, Cambi V, et al. Spontaneous renal allograft rupture without acute rejection. Acta Biomed. 2004;75:131–3.PubMed Busi N, Capocasale E, Mazzoni MP, Benozzi L, Valle RD, Cambi V, et al. Spontaneous renal allograft rupture without acute rejection. Acta Biomed. 2004;75:131–3.PubMed
43.
go back to reference Risaliti A, Sainz-Barriga M, Baccarani U, Adani GL, Montanaro D, Gropuzzo M, et al. Surgical complications after kidney transplantation. G Ital Nefrol. 2004;21 Suppl 26:S43–7.PubMed Risaliti A, Sainz-Barriga M, Baccarani U, Adani GL, Montanaro D, Gropuzzo M, et al. Surgical complications after kidney transplantation. G Ital Nefrol. 2004;21 Suppl 26:S43–7.PubMed
44.
go back to reference Sanchez de la Nieta MD, Sanchez-Fructuoso AI, Alcazar R, Perez-Contin MJ, Prats D, Grimalt J, et al. Higher graft salvage rate in renal allograft rupture associated with acute tubular necrosis. Transplant Proc. 2004;36:3016–8.CrossRefPubMed Sanchez de la Nieta MD, Sanchez-Fructuoso AI, Alcazar R, Perez-Contin MJ, Prats D, Grimalt J, et al. Higher graft salvage rate in renal allograft rupture associated with acute tubular necrosis. Transplant Proc. 2004;36:3016–8.CrossRefPubMed
45.
go back to reference Shahrokh H, Rasouli H, Zargar MA, Karimi K, Zargar K. Spontaneous kidney allograft rupture. Transplant Proc. 2005;37:3079–80.CrossRefPubMed Shahrokh H, Rasouli H, Zargar MA, Karimi K, Zargar K. Spontaneous kidney allograft rupture. Transplant Proc. 2005;37:3079–80.CrossRefPubMed
46.
go back to reference Martinez Mansur R, Piana M, Codone J, Elizalde F, Diez M, Duro J, et al. The rupture of the renal graft. Arch Esp Urol. 2006;59:489–92.PubMed Martinez Mansur R, Piana M, Codone J, Elizalde F, Diez M, Duro J, et al. The rupture of the renal graft. Arch Esp Urol. 2006;59:489–92.PubMed
Metadata
Title
Spontaneous renal allograft rupture complicated by urinary leakage: case report and review of the literature
Authors
Evaldo Favi
Samuele Iesari
Alessandro Cina
Franco Citterio
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2015
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-015-0109-3

Other articles of this Issue 1/2015

BMC Urology 1/2015 Go to the issue