Posterior lumbar fixation in a kidney transplant recipient: logistics and perioperative challenges.

BACKGROUND: Kidney transplantation has become the ideal and successful treatment for medically suitable patients with established kidney disease. This results in increased likelihood of these patients developing unrelated conditions requiring surgery, including spinal surgery. There are only a few publications available regarding spinal patients with renal transplants. CASE REPORT: A 67-year-old patient presented with recurrent sciatica. Four years prior to this, he received a living donor kidney transplant. He was diagnosed with right L4 radiculopathy due to recurrent foraminal stenosis as a result of the grade I L4/5 spondylolisthesis. He was offered a reoperation including microdecompression and postero-lateral fixation and fusion. The renal transplant necessitated specific pre- and intraoperative considerations. The knee-chest position with extra padding was used to maintain the region of the renal transplant free from any pressure. The renal care was planned in detail by the transplant surgeons and nephrologists and shared with the ward doctors and on-call teams. The procedure was uneventful; there were no signs of intraoperative or postoperative acute renal injury. The patient was discharged 5 days postoperatively; all renal parameters remained within normal ranges and the postoperative plain films demonstrated satisfactory surgical results. CONCLUSIONS: The key to success was a multidisciplinary approach and detailed planning regarding pre-, intra- and postoperative care. The presented scheme of care might be useful when considering the posterior approach and prone positioning in kidney transplant recipients with spinal pathologies requiring surgical treatment.

Severe peri-renal sepsis in established renal failure masquerading as an acute abdominal catastrophe.

Severe worsening lactic acidosis in an elderly patient following an episode of atrial fibrillation, who is not haemodynamically compromised, usually indicates an intra-abdominal vascular catastrophe. We describe a unique case of severe peri-renal sepsis in a patient with long-standing dialysis-dependent chronic kidney disease unrelated to urolithiasis that masqueraded as an acute abdominal condition requiring emergency laparotomy and nephrectomy.