Post-Transplant Nephroptosis as a Cause of Recurrent Urinary Tract Infections: A Case Report.

ABSTRACT

BACKGROUND: The aim of this study was to present a rare cause of recurrent urinary tract infections (UTIs) in a patient after kidney transplantation. METHODS: The patient's consent was obtained, and full medical documentation was reviewed. After analyzing the literature, only 3 case reports of post-transplant nephroptosis were found. RESULTS: A 32-year-old woman with a history of type 1 diabetes, after kidney and pancreas transplantation a year earlier, was admitted to the hospital due to another incident of fever, dysuria, and pain in the lower abdomen. UTIs had been recurring for several months despite prophylaxis, initially with co-trimoxazole and then with fosfomycin. There were no anatomic abnormalities, and tacrolimus concentrations always remained at the lower range of normal. Kinking of the ureter was suspected because of a change in the position of the transplanted kidney. Ultrasonography performed in the standing and lying positions confirmed the diagnosis. A double J catheter was inserted into the ureter. In the following months, no UTI or urinary retention recurrence was observed. CONCLUSIONS: Nephroptosis of a transplanted kidney is extremely rare. The standard place for graft implantation-the iliac fossa-significantly limits the potential for migration. Kidneys implanted intraperitoneally also do not show clinically significant mobility due to postoperative adhesions. Floating kidneys potentially lead to serious complications. In addition to pain, a migrating graft may cause urine retention, predisposing to UTI and acute kidney injury.