Abstract:
Injuries in renal graft are mostly caused by blunt trauma to the abdomen in any time after
transplantation. The response to a trauma depends on the balance between inflammatory and antiinflammatory
mediators. Trauma associated renal failure can be confused with acute humoral/cellular
rejection in an allograft recipient. Delay in diagnosis and appropriate treatment can cause loss of
graft in those patients. A 27-year-old male patient underwent renal transplantation because of
unidentified end-stage renal failure. He was admitted to emergency department with abdominal pain
on graft region, hematuria and oliguria. He informed that he fell down on his bottom from tabouret in
the bath before onset of the complaints. After observing hematoma in renal pelvis of the transplanted
kidney by urinary ultrasonography, an ureteral double J stent was applied. The serum creatinine level
continuously increased, anuria was observed and creatinine level rose to 7.9 mg/dL. The patient was
treated with pulsed doses of methylprednisolone, anti-thymocyte globulin because of acute allograft
rejection with preliminary diagnosis. But both radiological findings of renal allograft and the
performed immunological tests excluded the diagnosis of renal acute allograft rejection and confirmed
the renal kidney failure due to post-traumatic blood clots in the renal pelvis and ureter of the
allograft. Then he was discharged with functional graft through applied medical interventions.The
application of basic immunophenotyping protocols together with clinical assessment may help to
distinguish rejection from the other situations in renal transplant recipient with acute renal failure
following blunt trauma.
