Kidney Week

Abstract: SA-PO0362

Hydronephrosis Secondary to Retroperitoneal Fibrosis Associated with Inflammatory Abdominal Aortic Aneurysm

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

• Abbas, Fakhar, HCA Westside Hospital, Plantation, Florida, United States

Fakhar Abbas, MD

• Gadh, Rajdeep S., HCA Westside Hospital, Plantation, Florida, United States

Rajdeep S. Gadh, MD

• Malpartida, Freddy Rick, HCA Westside Hospital, Plantation, Florida, United States

Freddy Rick Malpartida, MD

• Jacob, Radu, HCA Westside Hospital, Plantation, Florida, United States

Radu Jacob, MD

Introduction

Abdominal aortic aneurysm accounts for 3–10% of cases and approximately 1.3% of deaths among men aged 65–85 years in developed countries. Hydronephrosis secondary to retroperitoneal fibrosis from inflammatory abdominal aortic aneurysm a rare urological complication. Management focuses on aneurysm repair, which often relieves urinary obstruction; however, careful preservation of ureteral adhesions during surgery is essential to prevent injury. Most remain asymptomatic until rupture, making timely surgical repair crucial for large or symptomatic aneurysms, while smaller aneurysms are generally managed with surveillance.

Case Description

A 65-year-old male who presented with acute kidney injury, bilateral ureteral obstruction resulting from retroperitoneal fibrosis due to an inflammatory abdominal aortic aneurysm. Imaging showed a stable fusiform infrarenal abdominal aortic aneurysm Fig:1. A nuclear renal scan demonstrated differential function of 82% in the left kidney and 18% in the right kidney. The patient was treated with immunosuppressive therapy, including prednisone and mycophenolate mofetil. Despite persistent reduced right renal function, the patient has maintained stable CKD stage 3A with appropriate medical management and careful monitoring.

Discussion

Degeneration of the elastic media within an atherosclerotic aorta, driven by inflammation and proteolytic activity, weakens the aortic wall and leads to aneurysm formation. Extension of retroperitoneal inflammation may encase the ureters, causing obstruction and hydronephrosis resulting in acute kidney injury. Early ureteral stenting, immunosuppressive therapy, and multidisciplinary management help preserve renal function, while lifelong surveillance is required for recurrent hydroureteronephrosis, recurrent kidney injury and chronic kidney disease.

Acknowledgment

In patients with flank or lower abdominal pain and an infra-umbilical aneurysm, early recognition and treatment of ureteral obstruction are crucial to prevent irreversible renal damage. Despite postoperative improvement in inflammation, persistent fibrosis may lead to recurrent kidney injury and chronic kidney disease, requiring lifelong surveillance.