Spontaneous bilateral renal pelvis thrombus formation presenting as anuric acute renal failure

A 59-year-old woman was admitted to the internal medicine service after presenting to the emergency department with complaints of abdominal pain and hematuria. Upon further evaluation, the patient was found to be significantly coagulopathic secondary to the intentional ingestion of brodifacoum, the active ingredient in D-Con rat poison, in an attempt to commit suicide. The patient was treated and discharged only to return several days later with new pain and the inability to urinate. She was found to be in acute renal failure and renal ultrasonography revealed bilateral ureteral and renal pelvis thrombus leading to acute obstructive nephropathy. She was taken emergently to the operating room for placement of bilateral ureteral stents which resulted in decompression of her collecting system and resolution of her renal failure.