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Abstract: FR-PO183

It's Not What It Looks Like: Obstructive Nephropathy in a Patient With Cervical Cancer

Session Information

Category: Onconephrology

  • 1600 Onconephrology


  • Reed, Christine E., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Lodhi, Sameed Khalid, UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Derebail, Vimal K., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Reynolds, Monica Lona, UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Zeitler, Evan, UNC Kidney Center, Chapel Hill, North Carolina, United States

Genitourinary complications may result from pelvic radiation therapy. We present a patient with history of cervical cancer with radiation-induced inflammation leading to recurrent obstructive nephropathy.

Case Description

A 35-year-old woman with history of stage III C1 cervical cancer treated with cisplatin, external beam radiation and brachytherapy presented with flank pain and urinary frequency with acute kidney injury (AKI). Medications included acetazolamide and ibuprofen. Exam revealed BP 150/98, and bilateral flank tenderness. Creatinine was 8.3 mg/dL from baseline 0.6 mg/dL three months prior, just after completing chemoradiation; urine protein-creatinine ratio was 8.1. Renal ultrasound revealed only mild bilateral hydronephrosis. With lack of clear etiology, she was empirically treated with intravenous steroids for suspected NSAID-related acute interstitial nephritis which improved creatinine rapidly (Figure). Kidney biopsy revealed acute tubular necrosis and steroids were discontinued. She was readmitted 3 days later for recurrent flank pain and AKI. Cystoscopy revealed bladder erythema with bullous edema obstructing the ureteral orifices. Prednisone was restarted with a taper, with initial improvement of creatinine but then recurrent AKI. Bilateral percutaneous nephrostomy tubes were placed, followed by ureteral stents with stabilization of creatinine.


We report a case of severe radiation-induced ureteral and bladder inflammation leading to recurrent obstructive nephropathy three months after radiation. Unique aspects include the early onset, involvement of both ureters and bladder, lack of significant hydronephrosis on imaging and profound initial response to steroids. A high index of suspicion for radiation-related obstructive nephropathy should persist, despite an absence of overt hydronephrosis, when evaluating AKI in patients with prior pelvic radiation.