Urinothorax associated with VURD syndrome.
VURD syndrome is a congenital genitourinary anomaly combining posterior urethral V alves, U nilateral vesicoureteral R eflux and renal D ysplasia. We report on a case of VURD syndrome presenting with acute renal failure and respiratory distress syndrome due to urinothorax. Urinothorax is a rarely reported complication of obstructive uropathy, but has not been linked to VURD syndrome. The diagnosis of urinothorax was confirmed by demonstration of a pleural fluid to serum creatinine ratio greater than one. Without tube thoracotomy drainage, urinothorax resolved rapidly after urinary catheterization and the renal recovery was also excellent after primary valve ablation. We discuss the diagnosis and management of urinothorax and the possible protective effect of urinoma, urinothorax, and unilateral vesicoureteral reflux on the renal function. We consider that urinothorax and urinoma may be deemed to be the extension of the clinical spectrum of VRUD syndrome. Excellent renal prognosis in our case also favors the protective effect provided by the buffer of pressure from unilateral vesicoureteral reflux, urinoma and urinothorax.
Lee
Chien-Chang
CC
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Fang
Cheng-Chung
CC
Chou
Hung-Chieh
HC
Tsau
Yong-Kwei
YK
D005122:Exudates and Transudates / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities*; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism*; D013902:Radiography, Thoracic; D013577:Syndrome; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014556:Urine; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery