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Kidney Week

Abstract: PO0298

Bilateral Hydronephrosis: An Unusual Presentation of a Rare Disease

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Ouda, Osama S. r., Abu Dhabi Health Services Co, Abu Dhabi, Abu Dhabi, United Arab Emirates
Introduction

Eosinophilic cystitis is a rare disease. Prevalence is equal among gender in adult patients. Patients commonly present urinary frequency, dysuria, hematuria, suprapubic pain and urinary retention. Association with history of allergy and urinary tract infection is variable.

Case Description

26 years old female presented with bilateral flank pain and dysuria. Labs showed high creatinine and urinalysis was suggestive of a urinary tract infection.CT of the abdomen and pelvis showed bilateral hydronephrosis with no stones (Image A). Diffuse circumferential wall thickening of urinary bladder with extensive perivesical fat stranding (image B). Cystoscopy was performed which revealed diffuse edematous bladder wall including both ureteric orifices. Bilateral retrograde studies confirmed that the obstruction is at the ureteral orifices. JJ stents were inserted bilaterally. Bladder biopsies were taken. Histopathology of the biopsies(image A and B) show denuded urothelium with underlying chronic inflammatory cell infiltrate rich in eosinophils consistent of eosinophilic cystitis. The renal function improved after the procedure. The patient was discharged on antihistamine and a tapering dose of steroid. On follow up, JJ stents were removed and retrograde studies showed normal flow through the ureteral orifices. Serum creatinine is back to baseline and dysuria improved on three months follow up.

Discussion

Eosinophilic cystitis is a rare disease. Association with history of allergy and urinary tract infection is variable. Radiological finding are usually consistent with thickened bladder wall.In a case series of 10 Chinese patients, only one patient had bilateral hydronephrosis. Medical treatment is mainly by non-steroidal anti-inflammatory drugs, corticosteroids, anti-histamines and antibiotics. Surgical modalities of treatment include transurethral resection of the lesions, partial cystectomy or total cystectomy. Response to different modalities of treatment is variable.