Abstract: SA-PO0363
Postoperative Reflex Anuria in a Patient Without Kidney Disease History
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
- Lightman, Rebecca, MaineHealth, Portland, Maine, United States
- Mahmoud, Hassan, MaineHealth, Portland, Maine, United States
Introduction
Reflex anuria is a rare cause of potentially severe acute kidney injury (AKI). It has been defined as cessation of urine output from the kidneys as a result of irritation, trauma, or painful stimulus to a ureter, kidney, or pelvic organ. A proposed mechanism for this phenomenon is heightened autonomic excitability following these stimuli. The following case provides an example of reflex anuria which was promptly identified and addressed, allowing for swift improvement without further progression of renal injury.
Case Description
A 72-year-old female with no prior history of kidney disease underwent colorectal surgery including colostomy reversal and hernia repair. Bilateral ureteral stents were placed pre-operatively in anticipation of the procedure, with stent removal upon completion of the case. Following her operation, the patient developed oligoanuria as well as an acute increase in creatinine from 0.86 (consistent with her previous baseline) to 3.53.
The differential of this AKI included acute tubular necrosis (ATN) secondary to hypoperfusion, however intra- and post-operative blood pressures were stable making ATN less likely. Reflex anuria secondary to stenting was also considered.
The patient received substantial fluid resuscitation and underwent retrograde pyelogram without obvious filling defects or significant hydronephrosis. New bilateral ureteral stents were placed, with subsequent rapid improvement in urine output and normalization of creatinine. Without other clear cause of AKI, her presentation was ultimately attributed to reflex anuria.
Discussion
Documented possible triggers of reflex anuria include ureteral manipulation or unilateral obstruction, pelvic or abdominal procedures, and acute coronary syndrome. Because of the rarity of reflex anuria, it is possible it may not be considered upon recognition of an AKI, or that diagnosis may be delayed. In this patient's case, the timely consideration of reflex anuria as a source of AKI may have prevented further progression of the patient’s kidney injury as well as future associated interventions including dialysis. Reflex anuria should be considered in patients with AKI following intra-pelvic procedures or known triggers of this rare condition.