Abstract: TH-PO0245
De Novo Kidney Stones in Native Kidneys After Liver-Kidney Transplant
Session Information
- Bone and Mineral Metabolism: Clinical Reports and Practice
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Gianella, Fabiola, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Williams, James C., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Song, Li, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Maalouf, Naim M., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Moe, Orson W., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Introduction
Metabolic syndrome (MS) features are associated with increased risk for uric acid nephrolithiasis (UAN). While hepatic steatosis is a feature of the MS, its association with UAN has not been established. We describe a patient with hepatic steatosis resulting in end stage liver cirrhosis and chronic anuric hepatorenal syndrome (HRS) requiring hemodialysis. After a combined liver-kidney transplant, she developed de novo UAN in her native kidneys at the same time as she developed steatosis in her transplanted liver.
Case Description
A 60-year-old Hispanic female with history of obesity, diabetes, hypertension, obstructive sleep apnea, and hypertriglyceridemia had liver cirrhosis due to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) via biopsy in 2014. In 2020, she was hospitalized for spontaneous bacterial peritonitis and acute kidney injury due to hepatorenal syndrome (HRS), becoming completely anuric and requiring hemodialysis. In 2020, she underwent a combined liver-kidney transplant from a deceased donor and was discharged with normal kidney function. A CT scan in 2021 revealed a new 3 mm calculus in the right native kidney. In 2023, she had renal colic with calculi in the native right kidney and ureter necessitating ureteroscopic removal of stone (URS) (100% uric acid). In 2024, she underwent URS for a left proximal ureteral stone (80% uric acid, 20% calcium oxalate). A technetium 99m MAG-3 furosemide scan with renal split function showed 10.4% (left native kidney), 11.7% (right native kidney), and 77.9% (transplanted kidney). Urine sampled from the bladder and the left native ureter showed pH of 5.42 and 5.59 and NH4/cNAE of 0.77 and 0.56, respectively. MRI performed in 2025 showed signs of hepatic steatosis and fibrosis in the transplanted liver. She was started on K-citrate 30mEq/day.
Discussion
The case illustrates the return of the renal function from HRS when presented with a new hepatic environment. The native kidneys contribute approximately 22% of total renal function and developed uric acid lithogenesis. The transplanted liver already showed signs of steatosis, likely secondary to the metabolic syndrome. The transplanted kidney did not have sufficient time to develop steatosis, but the native kidneys already have the propensity for stone formation and are reacting to the hepatic environment.