Elsevier

Transplantation Proceedings

Volume 49, Issue 10, December 2017, Pages 2381-2383
Transplantation Proceedings

Original Contributions: Case Reports
Kidney transplantation
Nephrogenic Adenoma Complicating Renal Transplantation: A Case Report and Discussion

https://doi.org/10.1016/j.transproceed.2017.09.003Get rights and content

Highlights

  • Nephrogenic adenomas are an underrecognized entity in the renal transplant population.

  • Although a benign lesion, nephrogenic adenomas may be associated with significant morbidity.

  • Management of nephrogenic adenoma can be problematic because recurrence after resection is common.

Abstract

Nephrogenic adenoma (NA) is a benign adenomatous lesion of the urinary tract. Long considered to be a rare phenomenon, case series from the renal transplant population suggest that it may be much more common within this group. Although NA is considered to be a lesion with low premalignant potential, hematuria, lower urinary tract symptoms, and recurrent urinary tract infections (UTIs) are frequently observed in the context of NA. Furthermore, after resection of NA, lesion recurrence and persistent symptoms are frequently observed. Here we present the case of a 69-year-old male renal transplant recipient with NA and associated recurrent UTIs despite cystoscopic resection of the primary lesion. This case is illustrative of the clinical impact of NA and the need for ongoing work into the development of strategies to manage this problematic phenomenon.

Section snippets

Case Report

Mr RB was a 69-year-old man who underwent cadaveric renal transplantation for end-stage kidney disease secondary to antibiotic induced interstitial nephritis, after 3 years of hemodialysis. Graft cold ischemia time was 9 hours, with 30 minutes of warm ischemia time. One HLA mismatch and no donor-specific antibodies were present. Donor and recipient cytomegalovirus statuses were negative and positive, respectively. Immediate graft function was observed, and immune suppression was maintained with

Discussion

Adenomatous growths with a marked histologic similarity to renal tubules were first characterized by Davis in 1949, and the term “nephrogenic adenoma” (NA) was introduced by Friedman and Kuhlenbeck the following year [1], [2]. Despite having long been considered to be an uncommon lesion, case series in the renal transplant (RT) recipient population have demonstrated a prevalence within this group of 0.53%–4.84% [3], [4]. As such, NA can not be considered to be rare among RT recipients.

Conclusion

The case reported here highlights the capacity for NA to cause significant morbidity despite best management with cystoscopic resection. Further work is required to fully elucidate the pathogenesis of this lesion and to identify strategies for the management of persistent UTI and recurrence in NA patients, particularly in the RT population.

Acknowledgments

Thank you to the staff in the departments of Nephrology and Anatomical Pathology at St. Vincent's Hospital Melbourne for facilitating this work.

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