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We report a case of cystinuria with staghorn renal lithiasis in a solitary right kidney and chronic renal failure. Right nephropyelolithotomy was performed and although 29 renal calculi were extracted many stones remained in situ. A permanent nephrostomy was left in the kidney. Several months later the urine was infected chronically with a ureolytic Citrobacter freundii bacteria and urinary pH oscillated between 8.0 and 9.2. Spontaneous dissolution of the cystine calculi was observed and many tiny fragments of cystine were expulsed through the nephrostomy, following which renal function improved. Despite the conditions favoring struvite calculi, formation did not occur.

We report the first case of congenital renal arteriovenous fistula in which renin-mediated arterial hypertension was the only clinical manifestation.

In 43 renal transplant patients studied by ultrasonography there were 32 episodes of acute rejection and 17 of acute tubular necrosis. The size of the kidney increased in all cases. However, in 75 per cent of the patients with acute rejection the central echoes of the renal sinus increased conspicuously, while in 77 per cent of those with acute tubular necrosis the echogenicity of the central sinusal complex decreased. These findings may be expressions of different pathological lesions at the renal sinus level in patients with acute rejection and acute tubular necrosis, which would modify the acoustic interphase. Therefore, we have found panniculitis, vasculitis, thrombosis and inflammatory cellular infiltration of the urinary collecting systems to be significant in patients with acute rejection but not in those with acute tubular necrosis. Ultrasonography can be an adjuvant instrument for the sometimes difficult differential diagnosis between acute tubular necrosis and acute rejection immediately after transplantation, and also for the diagnosis of acute rejection whenever it appears.