Post-renal acute renal failure due to a huge bladder stone

Area of Science:

• Nephrology
• Urology
• Radiology

Background:

• Acute renal failure (ARF) can stem from various causes, including urinary tract obstruction.
• Large bladder stones are an uncommon but serious cause of post-renal ARF.
• Timely diagnosis and intervention are crucial to prevent irreversible kidney damage.

Observation:

• A 63-year-old male presented with severe ARF (BUN/creatinine: 63/848).
• CT scan revealed a massive bladder stone (5x6x5 cm) causing bilateral ureterohydronephrosis.
• The patient required immediate catheterization and four sessions of hemodialysis.

Findings:

• Surgical removal via cystolithotomy yielded a 200g calcium phosphate and magnesium ammonium phosphate stone.
• Post-obstructive renal function significantly improved after stone removal.
• Cystoscopy confirmed bladder trabeculation and complete outlet obstruction by the stone.

Implications:

• This case highlights the rare but critical link between large bladder stones and severe post-renal ARF.
• Early diagnosis and intervention are crucial to prevent stone growth and subsequent renal failure.
• Prompt management involving hemodialysis and surgical stone extraction can lead to favorable outcomes.