Acute renal failure caused by blunt trauma in a kidney transplant recipient

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.