Hematuria post transplant

Haematuria in the immediate postoperative period following renal transplantation is a common occurrence, with a prevalence of approximately 12%. While often benign, it can also indicate serious complications that may threaten graft survival and patient health.

Causes

Benign Causes: These include surgical trauma to the urinary tract, catheterization injuries, and ischemia-reperfusion injury. Such causes are typically self-limiting and resolve with conservative management.

Infectious Causes: Immunosuppressive therapy increases susceptibility to urinary tract infections (UTIs). UTIs are a significant cause of haematuria and can lead to acute graft pyelonephritis, which may adversely affect graft function .

Vascular Complications: Rarely, life-threatening haematuria can result from complications like transplant renal artery pseudoaneurysms, which may present as massive haematuria due to retroperitoneal hematoma

Graft Rejection and Recurrence of Primary Disease: Haematuria can be an early sign of acute rejection or recurrence of the original kidney disease, such as focal segmental glomerulosclerosis (FSGS) .

Management Approach

Initial Assessment: A comprehensive evaluation including history, physical examination, and laboratory tests (urinalysis, urine culture, renal function tests) is essential to identify the underlying cause.

Imaging Studies: Ultrasound with Doppler can assess graft perfusion and detect complications like hydronephrosis. Further imaging, such as CT urography or cystoscopy, may be required based on clinical findings.

Treatment Strategies: Management is tailored to the identified cause. UTIs are treated with appropriate antibiotics. Surgical interventions may be necessary for structural abnormalities or malignancies. In cases of graft rejection, biopsy and adjustment of immunosuppressive therapy are indicated.

Conclusion

Haematuria in the immediate postoperative period of renal transplantation requires prompt and thorough evaluation to determine its cause. Early identification and appropriate management are crucial to prevent potential complications and ensure optimal graft function.

by Dr Ankit Gupta, Narayana Hospital, Gurugram