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differential, BUN, and creatinine. The fluid collection is differentiated from a urinoma or a serum collection. If hydronephrosis is diagnosed by an imaging study, it is critical that investigation for perinephric fluid collection is undertaken prior to consideration for percutaneous nephrostomy or other invasive procedures.

There are multiple treatment options for a lymphocele. The standard principle is that intraperitoneal drainage of the lymphocele should be established. This can be accomplished surgically with either a laparoscopic approach or an open surgical approach with marsupialization of the edges of the lymphocele. Caution must be undertaken during surgery to avoid injury to the pelvic collecting system and the ureter of the transplant kidney. Intraoperative ultrasound may be a useful complementary procedure if the lymph collection can not be definitively differentiated from a dilated renal pelvis. In some instances, percutaneous drainage is undertaken. However, this has a higher risk of infection and the disadvantage of requiring an external drain in place for extended periods of time. Patients recover from the laparoscopic and open surgical procedures in less than 2 days. One should expect immediate resolution of hydronephrosis, improved diuresis, and correction of hypercreatinemia. Interestingly, some have hypothesized that lymph collection may be hastened by an ongoing acute rejection episode. Therefore, if prompt correction of hypercreatinemia does not occur, acute rejection should be suspected and diagnosed by renal biopsy.

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