Abstract: SA-PO0356
Reflex Anuria After Colorectal Surgery: A Rare Cause of Severe AKI
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
- Kudlapur, Nathan, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Rodriguez Gomez, Gloria Paulina, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Sula Karreci, Esilida, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Introduction
Reflex anuria is a rare and underrecognized phenomenon in which both kidneys abruptly cease urine production following ureteral manipulation or pelvic organ manipulation, even when the contralateral kidney is structurally intact. Delayed diagnosis can result in unnecessary renal replacement therapy.
Case Description
A 58-year-old man with recurrent sigmoid colon cancer underwent laparoscopic-converted-open low anterior resection with diverting loop ileostomy, requiring intraoperative bilateral ureteral stent placement for identification. Past medical history was notable for type 2 diabetes, COPD, and chronic back pain, with no prior kidney disease (baseline creatinine 1.0 mg/dL). Postoperatively, he developed gross hematuria followed by abrupt, complete anuria, with creatinine rising to 11.5 mg/dL over five days. Renal ultrasound showed no hydronephrosis, and AKI was initially attributed to acute tubular necrosis in setting of perioperative hypotension and NSAID exposure. CT angiography to exclude renal vein thrombosis was precluded by his inability to lie flat due to back pain. Diuretic challenge failed, and he developed volume overload with severe hyponatremia (nadir 121 mmol/L), requiring a single session of hemodialysis. Reflex anuria was subsequently suspected, as the abrupt onset of hematuria and anuria were disproportionate to ATN. Bilateral retrograde pyelogram and ureteral stent placement were performed, with intraoperative visualization of edematous ureteral orifices and efflux of old hematuria bilaterally upon stent deployment. Following the procedure, he produced >3L of urine, creatinine rapidly normalized to 0.8 mg/dL, and electrolyte abnormalities resolved. The dialysis catheter was removed, and he was discharged with planned staged stent removal.
Discussion
This case illustrates a diagnostically challenging presentation of reflex anuria precipitated by intraoperative ureteral stenting. Notably, the absence of hydronephrosis on imaging, often incorrectly used to exclude obstruction, contributed to delayed recognition. The proposed mechanism involves autonomic nervous system-mediated ureteral spasm and renal arteriolar vasoconstriction. Clinicians should consider reflex anuria when AKI progression after pelvic surgery is atypical and anuria is abrupt and disproportionate to the presumed etiology.