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Kidney Week

Abstract: PO0046

Postrenal AKI due to a Rarely Seen Neoplastic Phenomenon in an Adolescent

Session Information

Category: Trainee Case Report

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Prashad cortez, Ana Lucia, Inova, Falls Church, Virginia, United States
  • Amin, Rasheda, Pediatric Specialists of Virginia, Fairfax, Virginia, United States
  • Varela, Carly R., Pediatric Specialists of Virginia, Fairfax, Virginia, United States
Introduction

AKI is an important cause of morbidity & mortality in adult and pediatric patients. Based on a lit review by Cleto-Yamane, et. al., the pediatric incidence & mortality of AKI in the USA in 2013 was 0.39% and 15.3%, respectively. In general, a patient’s presentation may provide clues to the etiology of AKI (i.e. prerenal, intrarenal and postrenal). AKI due to postrenal/obstructive causes is less common in children as compared to adults and is usually associated with congenital abnormalities e.g. posterior urethral valves, or acquired due to stones or tumors. We report the case of a 14 yo previously healthy female with a unique clinical presentation due to lower urinary tract obstruction secondary to a tumor.

Case Description

The patient presented with 3 weeks of back pain, R leg swelling, headaches, urinary frequency, n/v and hematuria. In the ED, her BUN and creatinine were 107 mg/dL and 21.1 mg/dL, respectively. A RUS showed enlarged non-echogenic kidneys with mild bilateral hydronephrosis & a heterogeneous pelvic mass. Further labs revealed anemia, low PTH, normal complement levels, ASO & ANA titers. A LE Doppler study was negative for venous thrombosis. A non-contrast MRI showed a pelvic mass & possible metastasis. Peds Oncology was consulted, and biopsies of bone marrow & pelvic tumor revealed a small round blue cell tumor with immunohistochemical stains diagnostic for rhabdomyosarcoma. She developed oliguria, hyperkalemia & hyperuricemia (24mg/dL). Rasburicase was given & CRRT was initiated. She received emergent chemotherapy with cyclophosphamide, doxorubicin & vincristine. Bilateral percutaneous nephrostomy tubes were placed with improvement in UOP & renal function allowing CRRT to be stopped. Labs showed a downward trend of BUN & creatinine to 14 mg/dL and 0.8 mg/dL, respectively.

Discussion

Our patient’s clinical presentation was atypical in that her initial US findings of mild hydronephrosis were not consistent with the severity of her renal injury. Her AKI was likely a combination of obstructive uropathy from the large pelvic tumor compressing her lower urinary tract & uric acid nephropathy. Decompression of the urinary system, management of hyperuricemia & initiation of tumor directed chemotherapy resulted in marked improvement of kidney function. Our case highlights the importance of considering an obstructive etiology in older children presenting with AKI.