[Post-renal transplantation intermittent anuria secondary to calcified granuloma of the neomeatus].

We report the case of a patient presenting with early ureteral obstruction secondary to a calcified granuloma in the ureterovesical junction after a right heterotopic renal transplantation. This granuloma variant has not been described in literature. A 34-year-old female with end-stage chronic renal failure secondary to systemic lupus erythematosus diagnosed in 1990 was admitted in the hemodialysis program in the year 2000. She had a history of hypersensitization, hyperparathyroidism secondary to chronic renal failure on treatment with cinacalcet (Mimpara) and calcitriol (Rocaltrol), and HT on treatment with atenolol, doxazocin, and amlodipine. She was admitted in March 2008 for related living donor renal transplantation (husband). The donor underwent an uneventful laparoscopic left nephrectomy, and a single artery and vein kidney and a well vascularized ureter of the proper length were obtained. As part of the desensitization protocol, the patient received two doses of rituximab, six sessions of pre-transplant immunoadsorption, and three doses of monoclonal gamma globulin and induction with thymoglobulin. Post-surgical immunosuppressor treatment consisted of mycophenolate sodium 750 mg p.o/12 h, tacrolimus 6 mg p.o/12 h, and diminishing regimen of prednisone down to 20 mg p.o/d. A heterotopic transplantation in the right renal fossa was performed, with termino-lateral anastomosis of the renal vein to the external iliac vein and termino-lateral anastomosis of the renal artery to the external iliac artery with continuous prolene 6 and 7/0, respectively; there was adequate perfusion after declamping, and no complications. A Politano-Leadbetter ureterovesical implantation was done, anchoring the distal end of the ureter with three loose poliglecaprone (Monocryl) 6/0 sutures, with immediate onset of diuresis. Warm ischemia time was 2 min, and total ischemia time was 50 min. A postoperative renal doppler ultrasound was normal, and an isotope renography showed adequate uptake. The patient’s kidney function improved; her creatinine level was 0.8 mg/ dL when she was released. The patient was readmitted 14 days later for pain at the level of the graft, anuria, and declining renal function, with a change in creatinine from 0.8 to 2.3 mg/dL. An abdominal ultrasound reported pyeloureteral ectasia up to the ureterovesical anastomosis, where a hyperechogenic image compatible with lithiasis was found. Diuresis was spontaneously reinitiated, and creatinine dropped to 0.5 mg/dL. An abdominal CT reported pyeloureteral ectasia in the kidney graft and ureteral dilatation with an intravesical calcified mass in the area of the ureteral anastomosis of the graft, which could correspond to a hematoma or a calcified Post-renal transplantation intermittent anuria secondary to calcified granuloma of the neomeatus