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Kidney Week

Abstract: SA-PO093

Unique Presentation of Hydronephrosis of a Transplanted Kidney from an Inguinal Hernia

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Fleischhacker, Alexander Nathaniel, University of Miami Health System, Miami, Florida, United States
  • Quo, Shane W., University of Miami Health System, Miami, Florida, United States
  • Klein, Elissa, University of Miami, Coral Gables, Florida, United States
  • Parianos, Mary, University of Miami Health System, Miami, Florida, United States
  • Padodara, Aakash, University of Miami Health System, Miami, Florida, United States
  • Waheed, Ahmed A., University of Miami Health System, Miami, Florida, United States
Introduction

End stage renal disease (ESRD) increases morbidity and worsens quality of life. Kidney transplants improve clinical outcomes in ESRD. This is a unique case of a post-renal acute kidney injury in a transplanted kidney secondary to a complicated right inguinal hernia.

Case Description

A 56-year-old male with history of right inguinal hernia and right kidney transplant on immunosuppression presented to the ED with a tender inguinal hernia for two days and inability to completely void. Prior attempts to reduce the hernia had been successful and notably improved his urinary symptoms. However, he could not longer reduce the hernia. On arrival, the patient was found to have a creatinine of 1.81 (baseline 1.1) and BUN of 32. A CT abdomen and pelvis showed a right inguinal hernia containing the distal ureter of the transplanted kidney and portions of the bladder. (Figure 1). General surgery was able to reduce the hernia. Once reduced, the patient began producing normal range urine output, and creatinine improved. He was transferred to a transplant facility for surgical evaluation. He underwent open inguinal hernia and incisional repair with mesh, which revealed bladder sidewall protruding through the hernia. Post-operatively, the patient continued to clinically improve, and his creatinine was near baseline.

Discussion

Kidney transplants provide an avenue without dialysis dependency and can increase life expectancy. We present a unique case of an AKI of a transplanted kidney due to complications from an inguinal hernia. Renal transplant recipients have unique changes to their anatomy, which can generate uncommon presentations of ordinary medical cases. We hope to raise awareness among physicians to diversify their differentials when encountering a transplant patient.