Kidney Week

Abstract: SA-PO0364

Steinstrasse and AKI in a Patient with Myeloproliferative Disorder

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

• Mulligan, Emma A., University of California San Diego, La Jolla, California, United States

Emma A. Mulligan, MD

• Trzebinska, Danuta, VA San Diego Healthcare System, San Diego, California, United States

Danuta Trzebinska, MD

• Rifkin, Dena E., VA San Diego Healthcare System, San Diego, California, United States

Dena E. Rifkin, MD

Introduction

Steinstrasse, the German word for “stone street,” describes the radiologic appearance of extensive renal stone burden lining the ureter. This mass of stones can cause obstructive acute kidney injury (AKI). It usually a complication of urologic procedures to remove stones. There are rare case reports of spontaneous steinstrasse without preceding urologic intervention. We report a case of steinstrasse in an older man with myelodysplastic syndrome who presented with AKI and bilateral ureteral uric acid steinstrasse.

Case Description

An 87-year-old man with JAK2 positive myeloproliferative neoplasm (MPN) was sent in for creatinine 6.0 mL/min/1.73m² from 3.2 a month prior. He had several years of gradual rise in creatinine and white blood cell count. His uric acid was 16 mg/dL and LDH 450 U/L. The differential included tumor lysis syndrome, MPN related nephropathy, and obstructive nephropathy. Imaging demonstrated bilateral moderate hydronephrosis with bilateral ureteral steinstrasse and numerous bladder calculi. The calculi were 80% uric acid and 20% calcium oxalate on analysis. He received rasburicase and allopurinol, underwent ureteral stent placement, and had stone extraction during admission. His creatinine improved to 3.5 over the next month and he underwent lithotripsy and cystolitholapaxy with 7 cm of stones removed.

Discussion

To our knowledge, this is first reported case of spontaneous uric acid steinstrasse. High cell turnover in MPN can lead to hyperuricemia, causing hyperuricosuria and uric acid nephrolithiasis and obstructive nephropathy. Spontaneous steinstrasse is a diagnosis to consider in patients who have an AKI with high cell turnover and hyperuricemia. Prompt diagnosis and individualized treatment are key in preventing permanent renal injury.

Bilateral moderate hydroureteronephrosis with ureteral steinstrasse and bladder stones (red arrows).