RESUMO
Povidone-iodine sclerosis has been suggested in the literature as a safe and effective treatment for post-renal transplant lymphoceles. No significant complications of this method have been described. We report on a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine instillations who developed acute renal failure secondary to iodine intoxication. Four days after the beginning of the povidone-iodine irrigations, metabolic acidosis was present, and renal function started to deteriorate. After a few days, despite the suspension of irrigations, the patient developed oliguria, and dialysis was needed. A renal biopsy was performed, and intense acute tubular necrosis was the only relevant finding. The lymphocele was corrected surgically, and the patient eventually recovered. As has been described in other settings, povidone-iodine instillation for the treatment of post-renal transplant lymphoceles may lead to iodine kidney toxicity and acute renal failure.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Transplante de Rim/efeitos adversos , Linfocele/tratamento farmacológico , Linfocele/etiologia , Povidona-Iodo/efeitos adversos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/cirurgia , Adulto , Ciclosporina/uso terapêutico , Diagnóstico Diferencial , Drenagem/métodos , Feminino , Humanos , Imunossupressores/uso terapêutico , Linfocele/diagnóstico , Linfocele/cirurgia , Povidona-Iodo/uso terapêutico , Recidiva , Diálise Renal/métodos , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/métodosRESUMO
CONTEXT: The incidence of lymphocele after renal transplantation varies between 0.6 and 18 percent of cases, and many factors have been associated to its etiology. Cellular rejection of the kidney allograft has been described as a possible causal factor of lymphocele. OBJECTIVE: To analyze the possible relationship between lymphocele and acute cellular rejection. DESIGN: A retrospective study. SETTING: A referral hospital center. SAMPLE: 170 patients submitted to kidney transplantation from March 1992 to January 1997. A standard technique for renal transplantation was used. RESULTS: Of the 19 patients that developed lymphocele, 16 presented at least one episode of acute cell rejection (84 percent), and were treated with methylprednisolone. The relation between lymphocele and rejection was statistically significant (p = 0.04). Treatment of lymphocele consisted of peritoneal marsupialization in 3 patients (15.3 percent), percutaneous drainage in 7 (36.8 percent), laparascopic marsupialization in 2 (10.5 percent), and conservative treatment in 7 patients (36.8percent. Evolution was favorable in 15 patients (78.9 percent), 1 patient (5.3 percent) died due to a cause unrelated to lymphocele, and 3 (15.8 percent) lost the graft due to immunological factors. The average follow-up period was 24.5 months. CONCLUSION: The high incidence of acute cell rejection in patients with lymphocele suggests a possible causal relationship between both conditions
Assuntos
Humanos , Masculino , Feminino , Linfocele/complicações , Transplante de Rim/imunologia , Rejeição de Enxerto/etiologia , Complicações Pós-Operatórias/etiologia , Metilprednisolona/uso terapêutico , Linfocele/cirurgia , Linfocele/tratamento farmacológico , Estudos Retrospectivos , Transplante de Rim/efeitos adversos , Laparoscopia/métodosRESUMO
CONTEXT: The incidence of lymphocele after renal transplantation varies between 0.6 and 18% of cases, and many factors have been associated to its etiology. Cellular rejection of the kidney allograft has been described as a possible causal factor of lymphocele. OBJECTIVE: To analyze the possible relationship between lymphocele and acute cellular rejection. DESIGN: A retrospective study. SETTING: A referral hospital center. SAMPLE: 170 patients submitted to kidney transplantation from March 1992 to January 1997. A standard technique for renal transplantation was used. RESULTS: Of the 19 patients that developed lymphocele, 16 presented at least one episode of acute cell rejection (84%), and were treated with methylprednisolone. The relation between lymphocele and rejection was statistically significant (p = 0.04). Treatment of lymphocele consisted of peritoneal marsupialization in 3 patients (15.3%), percutaneous drainage in 7 (36.8%), laparoscopic marsupialization in 2 (10.5%), and conservative treatment in 7 patients (36.8%). Evolution was favorable in 15 patients (78.9%), 1 patient (5.3%) died due to a cause unrelated to lymphocele, and 3 (15.8%) lost the graft due to immunological factors. The average follow-up period was 24.5 months. CONCLUSION: The high incidence of acute cell rejection in patients with lymphocele suggests a possible causal relationship between both conditions.