Abstract: TH-PO601
Young African American Male with Mild Bilateral Hydronephrosis and Kidney Failure
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Nguyen, Thuan Vinh, Olive View-UCLA Medical Center, Los Angeles, California, United States
- Cadacio, Caprice, Olive View-UCLA Medical Center, Los Angeles, California, United States
- Pham, Phuong-Thu T., UCLA Medical Center, Los Angeles, California, United States
- Pham, Phuong-Chi T., Olive View-UCLA Medical Center, Los Angeles, California, United States
Introduction
Retroperitoneal fibrosis (RPF) is a rare condition that requires high clinical suspicion for prompt diagnosis as routine imaging studies may be nondiagnostic.
Case Description
A 27-year old African American man presents with a 4-week history of constant aching pain of abdomen and back without associated consitutional symptoms.
Past history: unprovoked deep venous thrombosis of right leg and a recent episode of scotal swelling/ejaculation difficulty
Medication: apixaban
Exam: ill-appearing, blood pressure 130/75 mmHg
Unremarkable cardiopulmonary exam, minimally tender abdomen, bilateral costovertebral angle tenderness, trace bilateral lower leg edema
Labs:
Na 133, K 5.0, total CO2 25 meq/l, blood urea nitrogen 57 mg/dl, creatinine 12.55 mg/dl
Urinalysis bland
Renal ultrasound: mild hydronephrosis
Abdominal/pelvis CT without contrast: mild bilateral hydroureteronephrosis with inflammatory changes, no obvious mass/lymphadenopathy.
At the insistence of the renal team to rule out RPF, a CT urogram was performed which revealed an infiltrative mass encasing aorta, inferior vena cava, and commmon iliac vessels.
Evaluation for infectious, malignant, and vasculitic etiologies was negative. Laparoscopic biopsy revealed dense fibroadipose tissue, lymphocytic aggregates, focal scattered IgG4-positive plasma cells, and fibrin deposition. IgG4-related disease criteria not met.
Patient underwent bilateral nephrostomy placement with resolution of kidney failure with plan to initiate corticosteroids for presumed idiopathic RPF.
Discussion
RPF is a relatively rare condition that involves chronic inflammatory and fibrotic changes in the retroperitoneum that can lead to encasement and compression of retroperitoneal structures. Implicated etiologic factors including drugs, malignancy, infections, radiation, and trauma may be present in 30% of cases and idiopathic in all others. Prompt diagnosis relies on recognition of a classic clinical presentation (Figure) as initial imaging studies (non-contrast CT or ultrasound) may be falsely negative for significant obstruction.