URETERAL OBSTRUCTION AS A COMPLICATION OF RENAL-TRANSPLANTATION - A REVIEW

Ureteral obstruction in a renal allograft, due to a variety of etiolog ies, is both a challenging diagnostic and therapeutic disorder, Since ureteral obstruction in a renal transplant recipient usually presents as azotemia, it must also be distinguished from acute rejection, Altho ugh ultrasound is non-invasive and readily available, the most definit ive diagnostic tool is percutaneous nephrostomy tube placement with an tegrade nephrostogram. A variety of therapeutic approaches are availab le to treat ureteral obstruction in a renal allograft. These procedure s can be open (e.g., repeat ureteroneocystostomy) or utilize an endour ological approach (e.g., transluminal ureteral dilatation), From an ex perimental standpoint, recent data in rodent models of experimental hy dronephrosis demonstrate similar pathobiologic events in both the obst ructed kidney and an allograft undergoing; the chronic rejection proce ss, To this end, investigation needs to be conducted to assess whether partial, unrecognized ureteral obstruction in an allograft hastens th e development of chronic rejection, This would further underscore the importance of ureteral obstruction as a cause for not only acute azote mia in an allograft, but also chronic deterioration in renal transplan t function.