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Abstract: FR-PO849

Bilateral Ureteral Obstruction: Cause of AKI in Pregnancy

Session Information

Category: Women's Health and Kidney Diseases

  • 2200 Women's Health and Kidney Diseases


  • Kum, Roland Ngum, Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Thimmanagai, Kundana Reddy, Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Lefkowitz, Heather Rush, Newark Beth Israel Medical Center, Newark, New Jersey, United States

Pregnancy-related acute kidney injury (PR-AKI) has an incidence of about 2% (1). The incidence has decreased significantly over the past years in developed countries and this is attributed to improved antenatal care (2). A rare cause of PR-AKI is bilateral ureteral obstruction, which has been reported in only a few studies. We report the case of obstructive AKI in a pregnant woman at term who had complete reversal of AKI post delivery.

Case Description

A 27-year-old G1P1 female with no known medical history was admitted for induction of labour at 39 weeks. On the night of her admission, she experienced decreased urine output and a foley catheter was inserted. On the second day, she was anuric and repeat labs showed elevated creatinine. She received one litre bolus of IV fluids and one dose of IV Lasix (20 mg). However, her creatinine levels continued to rise and she developed metabolic acidosis. Her creatinine level on admission was 0.61 mg/dL, but it increased to as high as 3.11 mg/dL with a BUN of 29 mg/dL and an HCO3 of 19 mmol/L. Her electrolyte levels were normal, but her uric acid level showed 5.8 mg/dL. Her UA on admission was benign, and she was asymptomatic. Nephrology was consulted for acute kidney injury, and renal ultrasonography showed bilateral mild hydronephrosis of the kidneys. Vitals: blood pressure of 125/77 mmHg, heart rate of 80 BPM, respiratory rate of 18, oxygen saturation of 100% on room air, and temperature of 98.4°F. Nephrology recommended immediate delivery. Immediately after surgery, the patient had good renal recovery with normal creatinine levels of 0.8 mg/dL and very good urine output.


AKI is one of the complications that has high feto-maternal mortality and morbidity. Post renal cause of AKI secondary to ureteral obstruction is rare only 18 cases have been reported. Risk factors for AKI in pregnancy are polyhydramnios, twin pregnancy and obstruction of solitary kidney. (3) In normal pregnancy there is progesterone induced smooth muscle relaxation causing ureteral dilation and hydronephrosis. In our case ureteral dilation and hydronephrosis resulted from gravid uterus causing obstruction and possibly high levels of progesterone. The risk is usually greater in primigravida due to higher levels of progesterone.(4) AKI is rapidly reversible when the obstruction is relieved, with return of renal function to baseline.