Obstructive Nephropathy Without Hydronephrosis: Suspicion is the Key

• Published in: Urology (Ridgewood, N.J.) Vol. 101; pp. e9 - e10
• Main Authors: Esprit, Don H, MD, Koratala, Abhilash, MD, Chornyy, Volodymyr, MD, Wingo, Charles, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2017
• Subjects: Urology; urinary tract obstruction; acute kidney injury; hydronephrosis; retroperitoneal fibrosis
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2016.11.041

Abstract Urinary tract obstruction leading to acute kidney injury is usually associated with bilateral hydroureters and hydronephrosis, often accompanied by oliguria. We present an atypical case of obstructive uropathy without these features that presented with severe acute kidney injury. A 64-year-old male with no known past medical history has presented with a 2-week history of nausea, decreased appetite, flank pain, lower extremity edema and was found to have elevated creatinine of 10.5 mg/dL. Renal ultrasound showed mild prominence of the bilateral renal collecting systems with no evidence of hydronephrosis. CT scan showed findings suggestive of retroperitoneal fibrosis involving ureteral region and bilateral ureteral stent placement has led to dramatic improvement of creatinine to 1.3 mg/dL over the next four days.