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2017 ; 96
(43
): e8381
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Postrenal acute kidney injury in a patient with unilateral ureteral obstruction
caused by urolithiasis: A case report
#MMPMID29069033
Kazama I
; Nakajima T
Medicine (Baltimore)
2017[Oct]; 96
(43
): e8381
PMID29069033
show ga
RATIONALE: In patients with bilateral ureteral obstruction, the serum creatinine
levels are often elevated, sometimes causing postrenal acute kidney injury (AKI).
In contrast, those with unilateral ureteral obstruction present normal serum
creatinine levels, as long as their contralateral kidneys are preserved intact.
However, the unilateral obstruction of the ureter could affect the renal
function, as it humorally influences the renal hemodynamics. PATIENT CONCERNS: A
66-year-old man with a past medical history of hypertension and diabetes mellitus
came to our outpatient clinic because of right abdominal dullness. DIAGNOSES:
Unilateral ureteral obstruction caused by a radio-opaque calculus in the right
upper ureter and a secondary renal dysfunction. INTERVENTIONS: As oral hydration
and the use of calcium antagonists failed to allow the spontaneous stone passage,
extracorporeal shock wave lithotripsy (ESWL) was performed. OUTCOMES: Immediately
after the passage of the stone, the number of red blood cells in the urine was
dramatically decreased and the serum creatinine level almost returned to the
normal range with the significant increase in glomerular filtration rate.
LESSONS: Unilateral ureteral obstruction by the calculus, which caused reflex
vascular constriction and ureteral spasm in the contralateral kidney, was thought
to be responsible for the deteriorating renal function.