Chronic transplant rejection

This is a patient who is status post renal transplantation. In the left lower quadrant of the abdomen, there is a percutaneous nephrostomy tube as well as a nephroureteral stent within a left lower quadrant transplant kidney. In the right lower quadrant as indicated by the red arrows, there is a calcified mass with a reniform shape. This is the patients previous right lower quadrant transplant kidney which has failed. The reason why we can visualize the right sided transplant kidney so well as opposed to the left transplant kidney is because of the extensive calcification. The distribution of the calcification is diffuse but predominantly involves the cortex of the transplant kidney as opposed to the medulla. The findings are most consistent with chronic transplant rejection, which is the diagnosis in this case. The other most common cause of cortical nephocalcinosis is chronic glomerulonephritis.