ANURIA FOLLOWING BLUNT TRAUMA IN A RENAL-TRANSPLANT PATIENT

Renal transplantation is the preferred treatment for end stage renal disease. The expansion of patient selection criteria, and improvement in allograft survival and patient survival rates have increased the size of the recipient pool. These patients are at increased risk of renal injury after blunt trauma to the abdomen. The transplant kidney lacks the structural protection that a native kidney receives from the thoracic rib cage, and the thick posterior spinal and abdominal musculature. We report on a patient who presented with anuria and recurrent hypertension after receiving blows to the flank and abdomen. Ultrasonography and a quantitative renal scan suggested acute rejection. However, arteriography and computerized tomography (CT) confirmed a diagnosis of Page kidney due to compression by hematoma with evidence of active bleeding. Surgical exploration with decompression and evacuation of the perinephric hematoma resulted in prompt diuresis. By postoperative day 5 serum creatinine had returned to baseline and hypertension had resolved. To our knowledge we report the first case of Page kidney in a renal allograft recipient resulting from blunt trauma. CT is probably the most accurate initial imaging study in this situation. Surgical technique is discussed in detail. Prompt diagnosis and effective intervention will optimize chances of graft salvage.