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Reflex anuria from unilateral ureteral obstruction.
C Catalano1, E Comuzzi, L Davì
1Renal and Dialysis Unit, Monselice Hospital, Monselice, Padova, Italy. carletto.c@job.pd.it
Nephron
|February 28, 2002
Summary
Reflex anuria (RA) with acute renal failure is rare but possible in unilateral ureteral obstruction. Prompt diagnosis and stone passage can reverse RA and restore renal function.
Area of Science:
- Nephrology
- Urology
Background:
- Unilateral ureteral obstruction typically preserves renal function due to contralateral kidney compensation.
- Acute renal failure (ARF) associated with unilateral obstruction is uncommon, with reflex anuria (RA) being exceptionally rare.
Observation:
- A patient presented with 72-hour anuria and ARF after extracorporeal shock wave lithotripsy for a right renal pelvis stone.
- Initial evaluation revealed a hydronephrotic right kidney with obstructing stones and a normal left kidney.
- Resolution of anuria and ARF occurred after spontaneous passage of a ureteral stone.
Findings:
- This case highlights a rare instance of reflex anuria (RA) causing acute renal failure in the setting of unilateral ureteral obstruction.
- The proposed mechanism involves vascular or ureteral spasm, potentially linked to autonomic nervous system hyperexcitability.
- The patient's renal function normalized upon stone expulsion, indicating the reversible nature of the condition.
Implications:
- Nephrologists should consider reflex anuria in the differential diagnosis of acute renal failure, even in cases of unilateral obstruction.
- RA may be underreported, with only severe or well-documented cases appearing in the literature.
- Increased awareness could lead to better recognition and management of this rare but significant clinical entity.