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A case of acute kidney injury due to complex, partial, multifocal ureteral strictures

Nature Clinical Practice Nephrology volume 4, pages 102–108 (2008)Cite this article

Abstract

Background An 89-year-old man with a history of prostate cancer who had undergone radical prostatectomy 15 years ago presented with hyperkalemia (serum potassium level 6.9 mmol/l) and kidney failure (serum creatinine level 937 µmol/l [10.6 mg/dl]). Ultrasound scan of his kidneys showed mild bilateral hydronephrosis. Although placement of a bladder catheter led to an initial increase in glomerular filtration rate, the improvement was delayed and incomplete. Subsequently, the patient's glomerular filtration rate decreased acutely. This unusual biphasic course of kidney injury begged explanation.

Investigations Physical examination, measurements of serum creatinine level and electrolytes, imaging of the urinary tract (ultrasound and CT scans), and nephrostograms.

Diagnosis Acute kidney injury due to upper (multiple ureteral strictures bilaterally) and lower (urethral) urinary tract obstruction.

Management Placement of bladder catheter and percutaneous nephrostomy tubes followed by bilateral internal ureteral stents.

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Figure 1: Kidney function throughout the course of hospitalization.
Figure 2: Nephrostograms.
Figure 3: Schematic hydrodynamic models showing an interpretation of the events occurring in the patient.

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Acknowledgements

The author is indebted to Dr Christopher Morris, Dr Anant Bhave, and their superb team in the Division of Interventional Radiology at Fletcher Allen Health Care for their valuable contributions in this case. The author would also like to thank Professor Jason Bates and Professor Burton Sobel for reviewing the manuscript and for helpful discussions regarding the development of Figure 3.

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Author notes

  1. Division of Nephrology, Departments of Medicine, Molecular Physiology & Biophysics and Pharmacology, University of Vermont, 208 South Park Drive, Suite 2, Colchester, VT 05446, USA alan.segal@uvm.edu

Authors and Affiliations

  1. A Segal is an Associate Professor in the Division of Nephrology and Program Director of the Nephrology Training Program at the University of Vermont, Colchester, and Fletcher Allen Health Care, Burlington, VT, USA.,

    Alan Segal

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Segal, A. A case of acute kidney injury due to complex, partial, multifocal ureteral strictures. Nat Rev Nephrol 4, 102–108 (2008). https://doi.org/10.1038/ncpneph0698

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