Asem A Al Hiari.
Autonephrectomy of a Transplanted Kidney.
Pak J Med Sci Jan ;18(4):322-4.

Autonephrectomy is a radiological term used to describe the end stage renal tuberculosis, the kidney is totally calcified and non- functioning. In this case report a similar appearance in a transplanted kidney is presented in a patient with renal osteodytrophy. A 17-year old male patient presented with uremic symptoms. Physical examination was unremarkable apart from pallor and uremic smell. He was admitted with the following results: PCV 22 Ca 9.1mg/dl PO 4 10.5mg/dl Creatinine 11.5 mg/dl BUN 124 mg/dl Na 134 mEq/L K 4 mEq/L Alkaline Phosphates 898 IU Protein 70 gm/L GFR 6 ml/min. Renal ultrasound revealed small echogenic kidneys but no evidence of obstructive changes. Subcalvian catheter was inserted and the patient was started on regular hemodyalsis weekly. The patient was supplied with the following medications: CaCO3 500 mg Alfa calcidol 0.25g and folic acid. A year later he was admitted for live related kidney transplant from his cousin which was complicated by accelerated rejection for which he was given methyl prednisolone 1 gm LV for three days, and he was maintained on Cyclosporine 2cc, Immuran 50 mg and Prednisolone 60mg/day to be tapered over the coming six weeks. The patient continued to have reduced urine output with high levels of creatinine around (10mg/dl) over the following six months for which immunossuppressive drugs were discontinued and he was back on dialysis again. The patient was admitted again three years later with generalized bony aches, myalgias, and difficulty in walking. On examination he was anemic, BY 150/90 mmHg lying, chest had barrel shaped deformity with fine basal crackles, heart had mitral regurgitation murmur. Abdominal examination was unremarkable, upper limbs showed pseudoclubbing, lower limbs showed atrophic muscles with decreased power to 3/5 and no sensory deficit. Lab results showed: creatinine 13 mg/dl, Ca 7 mg/L, Alkaline Phosphatase 1200 U, PTH level 1200 mg/ml.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com