Objectives: To determine the morbidity and graft survival rate in kidney recipients aged between 6 and 18 years who had undergone kidney transplantation in Imam Reza Hospital, Mashhad, northeastern Iran during 1992-2009.Methods: Of 1585 kidney recipients who had undergone kidney transplantation in our center during 1992- 2009, 168 patients aged from 6–18. Neurogenic bladder, reflux nephropathy, posterior urethral valve, prunebelly syndrome and chronic glomerulonephritis were diagnosed to be the cause of renal failure in these patients.22% of the donors were related living, 66% were unrelated living and 12% were cadaveric. Immunosuppressive therapy was initiated with cyclosporine, mycophenolate mofetile, azathiporine and prednisolone. Kaplan-Meier survival analysis was used to assess graft and patient survival while log-Rank test was used to assess the effect of kidney source and the time of renal transplant.Results: All the studied patients developed immediate diuresis. Surgical complications included 2 urinary fistulas, 2 ureteral strictures and 3 clinical lymphoceles all of which were surgically managed. Chronic rejection and recurrence of the underlying renal disease were the most common cause of graft loss. Graft survival rate after 1, 2, 5, and 10 years of kidney transplantation were 97%, 88%, 79%, 65% and 53%, respectively.Conclusion: kidney transplantation in children results in physical growth improvement and mental development. Graft survival rate due to chronic rejection, underlying kidney disease recurrence and incompliance in taking medicines remain to be a problem.

Introduction: The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in horseshoe kidneys with calculi. Materials and Methods: Between 1995 and 2005, we performed PCNL in 9 patients with horseshoe kidney. In 3 of them, there was a single calculus and the rest had multiple calculi in the pelvis and at least 1 in the calyxes. Ultrasonography, plain abdominal radiography, and intravenous urography (IVU) were performed in all patients. We used fluoroscopy for entering the system and then, pneumatic or ultrasonic lithotripsy was used. Results: In all except 1 patient (88.9%) we could access the system. Single calculi in 3 patients were removed. In 5 patients with multiple calculi, the calculus causing obstruction was removed, and in 3, the calculi located in the calyxes were removed too. Consequently, 66.7% were stone-free at the end of the procedure. In 2 patients, there were residual calculi in the calyxes and they underwent candidates for extracorporeal shockwave lithotripsy.Conclusion: Percutaneous nephrolithotomy can be used in patients with horseshoe kidney if the patient selection is appropriate and the surgeon is experienced enough. The success rate and complications are the same as the patients with normal anatomy. However, access to the lower calyx is more difficult due to its anatomic status.

We present a rare complication of transplant renal artery stenting in a patient who developed subcapsular hematoma and presented as acute page kidney. We discuss possible mechanisms and successful novel management using radiological-assisted decompression. We propose considering this alternative option before proceeding with surgical exploration and renal capsulotomy.