Post-Renal Biopsy Nephro-Cutaneous Fistula: A Very Rare Complication After Transplant and Management Options

Abstract

Case History:

A 30-year-old man underwent live related kidney transplant. Postoperative urine output was about 150 mL/hour with persistently high creatinine of 4.5 mg%. Renal biopsy was done from upper pole under ultrasonic guidance. It was suggestive of acute tubular necrosis. Ultrasonography of the transplant kidney showed normal vascularity with hematoma at the superolateral pole of kidney. He presented again after 7 days with persistent significant urinary leak through the main operative site. Cystogram was normal with no contrast extravasation at the ureterovesical anastomosis. Retrograde pylography suggested nephro-cutaneous fistula with contrast extravasation at the upper pole. Retrograde Double-J stenting was done with flexible scope to drain the upper calyx. Leak was still persistent. On reexploration upper pole of the kidney was sloughed off with urinary leak through open pelvicalyceal system. Conservative debridement was done with keeping a nephrostomy. Nephrostomy and stent were removed sequentially. Patient is dry at the wound with urine output of ∼100 mL/hour with creatinine of 2.2 mg%.

Discussion:

Post-renal biopsy nephro-cutaneous fistula is a very rare complication with incidence reported in literature of <0.05%. Management options are retro/ante grade stenting, percutaneous nephrostomy, open surgical repair with debridement, and omentoplasty in resistant cases. Nephrectomy can be life saving occasionally.

Conclusion:

We are reporting a very rare complication of post-renal biopsy nephro-cutaneous fistula, which was managed with open surgical repair.

No competing financial interests exist.

Runtime of video: 5 mins 15 secs