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Kidney Week

Abstract: FR-PO216

Giant Abdominal Aortic Aneurysm (AAA): A Rare Cause of Obstructive Nephropathy

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Hernandez Garcilazo, Nora H., Yale School of Medicine, New Haven, Connecticut, United States
  • Brewster, Ursula C., Yale School of Medicine, New Haven, Connecticut, United States
Introduction

Obstructive nephropathy (ON) accounts for 5-10% of all cases of AKI. The most common causes include benign prostatic hyperplasia, kidney stones or malignancy. Only few cases have been reported of ON caused by a large abdominal aortic aneurysm (AAA) producing ureteral compression. We present the case of a patient whose severe renal failure only became evident after presenting to the hospital with impending AAA rupture.

Case Description

A 72-year-old male with long-term tobacco use and no medical care for >15 years presented with abdominal pain and dyspnea. He denied any fever, chills, nausea, vomiting, diarrhea, or poor oral intake. In ED, blood pressure was 163/93, but otherwise stable. Blood work showed a creatinine 14.0 mg/dl, BUN 149 mg/dl, K 5.3 mmol/L, CO2 6 mmol/L, anion gap 29, and normal LFTs. CT without contrast revealed an impending aortic rupture with aneurysmal dilation measuring 8.6 x 10.6 cm in axial diameter causing severe right-sided hydronephrosis and mildly atrophic left kidney. Dialysis was initiated for optimization of acid-base status for emergent endovascular repair. The next day he underwent percutaneous stent graft repair and had a right nephrostomy tube placed resulting in complete resolution of right hydronephrosis. Urine output improved; however, clearance was still impaired so dialysis was restarted and continued without adequate renal recovery.

Discussion

AAA is a rare and potentially fatal cause of ON. AAAs larger than 8 cm carry an annual rupture risk of 30-50%. Once this occurs mortality risk is extremely high, making emergency surgery the only alternative. Our patient’s case posed an added level of complexity as he was found to have acute renal failure requiring emergent dialysis for pre-op optimization. Although exceedingly rare, it is important to keep in mind aortic aneurysms as a cause of ON with the major difference from most other causes being the critical role prompt treatment plays in patients’ survival.

AAA causing severe hydronephrosis