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Kidney Week

Abstract: PO0316

A Case of Abrupt Anuria from Bilateral Kinked Ureters

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Sawaf, Hanny, Cleveland Clinic, Cleveland, Ohio, United States
  • Haile, Eiftu, Cleveland Clinic, Cleveland, Ohio, United States
  • Huml, Anne M., Cleveland Clinic, Cleveland, Ohio, United States
Introduction

Urinary tract obstruction is a well-known cause of reversible AKI. In patients with 2 functioning kidneys, bilateral ureteral obstruction is rare and unilateral ureteral obstruction rarely causes anuria and often does not result in a noticeable worsening of renal function. Here we describe a case of abrupt anuria and severe AKI secondary to bilaterally kinked ureters resembling parenchymal renal failure.

Case Description

A 58-year-old female with metastatic epithelioid mesothelioma underwent debulking peritonectomy, bilateral salpingioopherectomy, and omentectomy with hyperthermic intraperitoneal chemotherapy with cisplatin at 50 mg/m2. Bilateral ureteral catheters were placed preoperatively to avoid ureteral injury during surgery. The catheters were removed on post-operative day (POD) 0.

Post-operative course was initially uncomplicated with stable renal function and more than 2L urine output a day. On POD 2, she was noted to have abrupt anuria despite the presence of a functioning foley catheter. Her creatinine increased from 0.7 mg/dL to 2.3 mg/dL. Renal ultrasound revealed normal sized, echogenic kidneys with mild bilateral hydronephrosis. A CT cystogram with contrast was negative for a urinary leak.

On POD 3, she remained anuric. At this point there was concern for a dense ATN caused by cisplatin and initiation of renal replacement therapy was considered. Given a high degree of suspicion for ureteral obstruction, the patient underwent cystoscopy with bilateral retrograde pyelogram revealing significant bilateral ureteral kinking (see image). Bilateral ureteral stents were placed with brisk urine output noted intraoperatively and her renal function improved back to baseline.

Discussion

Obstruction can occur at any point in the urinary tract but tends to only cause anuric AKI with an obstruction below the level of the bladder for patients with 2 functioning kidneys. Obstruction at the level of the ureter generally does not cause anuric AKI except in rare bilateral cases. This case may represent reflex anuria in the setting of a combination of post-operative bilateral ureteral spasm, edema, and kinking.