Kidney Week

Abstract: SA-PO1195

Obstructive Uropathy Secondary to Constipation in a Kidney Transplant Recipient

Session Information

• Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Sternberg, Lauren Molly, University of Utah Health, Salt Lake City, Utah, United States

Lauren Molly Sternberg, MD

• Nguyen, Amanda M., University of Utah Health, Salt Lake City, Utah, United States

Amanda M. Nguyen, MD

• Lomanta, Francis Vincent, University of Utah Health, Salt Lake City, Utah, United States

Francis Vincent Lomanta, DO, MS

• Sherbotie, Joseph R., University of Utah Health, Salt Lake City, Utah, United States

Joseph R. Sherbotie, MD

Introduction

Acute kidney injury (AKI) is a major contributor to morbidity in kidney allograft recipients. Etiologies include recurrent disease, rejection, ischemia, infection, nephrotoxins, and obstructive uropathy. Early recognition and treatment are important to preserve allograft function.
Obstructive uropathy is a common, reversible cause of AKI, typically due to internal ureteral outflow obstruction by calculi or strictures, but may also result from extrinsic compression from nearby structures. Fecal impaction from chronic constipation is an exceptionally rare but preventable cause. It has been reported in patients with native kidneys, but it is even more rare in transplant recipients.

Case Description

We present a 13-year-old male with ESKD due to posterior urethral valves and vesicoureteral reflux who received an intraperitoneally placed living-related donor kidney transplant with ureteroneocystostomy and bilateral native nephroureterectomies at 6 years of age, who developed obstructive uropathy secondary to fecal impaction.
He presented with acute abdominal and flank pain, vomiting, and difficulty with voiding. He had no preceding illness or symptoms. Baseline creatinine was 1.3–1.5 mg/dL with chronic SFU grade 2–3 hydronephrosis. Foley catheterization yielded minimal output, and creatinine increased to 3.4 mg/dL within 24 hours despite fluids. Abdominal CT showed a large stool burden adjacent to the transplant ureter. CT cystogram demonstrated a distended bladder without reflux, raising concerns of ureteral obstruction.
A nephrostomy tube (NT) was placed with immediate improvement of urine output and symptoms. Antegrade nephrostogram showed a diffusely narrowed but non-focally stenotic ureter. His workup was negative for a bowel obstruction. With the resolution of his constipation, he began having intermittent voids per urethra. He was discharged with the NT to drainage. Follow-up nephrostogram and Whitaker test showed a small caliber but patent ureter without obstruction. The NT was capped without return of symptoms, and he voided roughly 2.5–3 L of urine per day. The patient’s symptoms have since resolved, and renal function has stabilized.

Discussion

This case demonstrates a rare cause of kidney allograft dysfunction secondary to fecal impaction and highlights the importance of maintaining an effective bowel regimen in transplant patients.