Abstract: SA-PO0355
A Rare Cause of AKI Due to Obstructive Uropathy During Pregnancy
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Mashayekhi, Mahtab, Loma Linda University Health, Loma Linda, California, United States
- Ganesan, Lakshmi, Loma Linda University Health, Loma Linda, California, United States
- Abdi Pour, Amir, Loma Linda University Health, Loma Linda, California, United States
Introduction
Acute kidney injury (AKI) during pregnancy is uncommon and requires prompt evaluation to identify reversible causes. Obstructive uropathy due to pelvic malignancy is a rare etiology that may present with nonspecific symptoms.
Case Description
A 36-year-old woman on her 5th pregnancy at 13 weeks and 2 days of gestation presented with progressively worsening bilateral flank pain and vaginal bleeding. Her history was notable for prior abnormal Pap smears without known kidney disease, hypertension, diabetes, or nephrolithiasis.
She presented with two weeks of worsening edema and persistent flank pain. Blood pressure was 141/85 mmHg. Laboratory evaluation revealed severe AKI with serum creatinine of 9.8 mg/dL, blood urea nitrogen of 67 mg/dL, metabolic acidosis, hyperkalemia of 5.1 mmol/L, hemoglobin 7.6 g/dL, and urinalysis with microscopic hematuria.
Renal ultrasound demonstrated nonobstructive bilateral renal calculi with mild bilateral hydronephrosis, proximal ureterectasis, and an irregular appearance of the bladder wall without bladder distention.
Percutaneous nephrostomy placement was performed, and subsequent CT scan showed persistent moderate right and mild left hydronephrosis, bilateral ureteral dilation, and bladder wall thickening (Figure 1).
Given her persistent vaginal bleeding, further gynecologic evaluation was pursued. Pelvic exam revealed a large (7–8 cm) infiltrative cervical mass. Cystoscopy identified a 2–3 cm polypoid lesion at the trigone. Biopsy of the cervical mass resulted in findings concerning for squamous cell carcinoma of the cervix.
Discussion
The presence of bilateral hydronephrosis initially, attributed to nephrolithiasis, masked the underlying diagnosis. Advanced cervical cancer may lead to ureteral obstruction and rapid deterioration of renal function. Pregnancy may further delay diagnosis due to overlapping symptoms and limitations in imaging modalities.