A 77-year-old man presented with acute graft dysfunction 25 years after a renal transplant in the left iliac fossa. He also had an asymptomatic left inguinal hernia. Renal ultrasound showed a significant pyelocalicial dilation of the kidney graft and the patient was submitted to a percutaneous nephrostomy. An antegrade nephrostogram was performed, which showed a dilated ureter and the bladder included in the left inguinal hernia that caused the obstructive uropathy. Concomitant retrograde cystography also showed a significant portion of the bladder in the hernia sac. The patient was submitted to inguinal hernia repair, which resolved the obstruction. We present a rare and potentially curable cause of obstructive uropathy in a transplant recipient; it is possible to revert graft dysfunction and prevent graft loss if the condition is recognised early.
2016 BMJ Publishing Group Ltd.