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A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction
Published on: December 20, 2014
[Two cases of infants with acute renal failure due to bilateral obstructive ureteral stones associated with rotavirus
Hidenori Zakoji1, Tatsuya Miyamoto, Manabu Kamiyama
1Department of Urology, Faculty of Medicine, University of Yamanashi.
Insights
Two infants developed acute renal failure from bilateral ureteral stones during rotavirus gastroenteritis. Prompt urinary drainage and alkalization led to stone excretion and recovery, highlighting a rare post-renal cause of kidney injury.
Area of Science:
- Pediatric Nephrology
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- Rotavirus gastroenteritis is a common cause of acute kidney injury in infants.
- Acute renal failure in infants can result from various causes, including dehydration and urinary tract obstruction.
Observation:
- Two infants presented with anuria and acute renal failure following rotavirus gastroenteritis.
- Diagnostic imaging revealed bilateral obstructive ureteral stones as the cause of post-renal failure.
Findings:
- Percutaneous nephrostomy tubes were inserted for urinary drainage, leading to rapid normalization of renal function.
- Excreted stones were identified as ammonium acid urate, a rare finding in developed countries.
- Urinary alkalization facilitated the excretion of ammonium acid urate stones.
Implications:
- This case highlights ammonium acid urate stones as a potential, albeit rare, cause of acute renal failure in infants with rotavirus gastroenteritis.
- Clinicians should consider post-renal obstruction due to urolithiasis in infants presenting with acute renal failure and gastroenteritis.
- Early diagnosis and intervention, including urinary drainage and alkalization, are crucial for favorable outcomes.
Abstract:
We report on 2 infants with acute renal failure caused by bilateral obstructive ureteral stones associated with rotavirus gastroenteritis. A 28-month boy and a 13-month boy with several days history of watery diarrhea and vomiting were referred to our hospital because of anuria. They were diagnosed acute post-renal failure due to obstructive bilateral ureteral stones based on the findings of ultrasound scan and computed tomography. Immediately, percutaneous nephrostomy tubes were inserted for urinary drainage, serum levels of creatinine and uric acid returned to normal within several days. Sandy stones were excreted through the nephrostomy tubes with urine after urinary alkalization, which were proved to be mainly ammonium acid urate. Ammonium acid urate is rare in developed countries, but some cases of bilateral urolithiasis causing acute renal failure in infants with rotavirus gastroenteritis were reported in recent years. It has been known that the cause of acute renal failure is renal azotemia resulting from sustained hypovolemia, but post-renal causes due to ammonium acid urate stones should be taken into consideration.
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