Acute kidney injury due to obstructive nephropathy caused by fecal impaction in a renal transplant patient - A case report

Abstract

Acute kidney injury (AKI) remains a major complication after transplantation; its common causes include acute rejection and urinary tract obstruction. Here, we report an unusual case of a 16-year-old renal transplant patient with congenital anomalies of the kidney and urinary tract (CAKUT) and anorectal malformation. She developed AKI owing to obstructive nephropathy caused by impacted stool in the colon. Our patient presented with complaints of hypertension and facial edema. She had a neurogenic bladder and a history of surgery for anal atresia. Abdominal computed tomography revealed renal hydronephrosis in the transplanted kidney and a mass of impacted stool in the sigmoid colon and rectum that compressed the neck of the bladder. Despite maintenance of daily defecation, the impacted stool had accumulated over several years; however, softening and removing the stool improved kidney function. Defecation management is therefore important in patients with CAKUT and anorectal malformation.

Keywords

• acute kidney injury
• congenital anomalies of the kidney and urinary tract
• obstructive nephropathy
• renal transplantation
• stool mass