Postural renal transplant obstruction - A case report and review of the literature

A 48-year-old woman underwent cadaveric renal transplantation for end-stage renal failure secondary to polycystic kidney disease. Nine months after tr ansplantation, intermittent renal dysfunction and severe graft hydronephros is developed despite the presence of a ureteric stent. A Tc-99m MAG3 scan p erformed with the patient standing showed complete transplant obstruction. Rapid tracer clearance with progressive bladder filling was present when th e patient was imaged in the supine position. Ureteric obstruction is the mo st common urologic complication of renal transplantation. However, postural ureteric obstruction has been described only rarely. This case indicates t hat posture may affect ureteric patency and highlights this potential pitfa ll in the evaluation of intermittent graft dysfunction by diuretic renograp hy.