Obstructive polyuric renal failure following renal transplantation

Area of Science:

• Nephrology
• Urology
• Transplant Medicine

Background:

• A patient with a functioning renal allograft developed acute renal failure, massive polyuria, and hypertension.
• The patient had a history of nephrectomy and received a renal transplant.

Observation:

• Acute renal failure presented with massive polyuria (excessive urine production) and hypertension.
• The polyuria was hypotonic, suggesting nephrogenic diabetes insipidus due to impaired water permeability in the collecting ducts.
• Urinary dilution and acidification tests indicated normal function of the ascending loop of Henle and distal convoluted tubules.

Findings:

• Relief of a periureteric obstruction led to rapid correction of renal failure, polyuria, and hypertension.
• Renal biopsy revealed normal glomeruli and intact tubular epithelial cells, supporting functional rather than organic damage.
• The rapid reversal of symptoms suggests that the renal dysfunction was reversible and likely due to functional changes.

Implications:

• Ureteric obstruction should be considered a potential cause of renal failure and polyuria in patients with kidney transplants.
• This case highlights that ureteric obstruction can be a correctable cause of hypertension in renal allograft recipients.
• Functional nephron changes, rather than irreversible damage, may underlie acute renal failure secondary to obstruction.