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


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


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


RESULTS
Placement of bladder catheter and percutaneous nephrostomy tubes followed by bilateral internal ureteral stents.
Segal
Alan
A
Division of Nephrology, Department of Medicine, University of Vermont, 208 South Park Drive, Suite 2, Colchester, VT 05446, USA. alan.segal@uvm.edu
D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003558:Cystoscopy; D004502:Education, Medical, Continuing; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications* / Q000175:diagnosis; D014546:Urinary Catheterization / Q000379:methods; D014563:Urodynamics