The bladder ran dry: bilateral ureteral obstruction.

Area of Science:

• Nephrology
• Urology
• Internal Medicine

Background:

• Acute kidney injury (AKI) can arise from multifactorial causes, including dehydration, nephrotoxic medications, and urinary tract obstruction.
• Bilateral ureteral obstruction leading to anuria is a rare clinical presentation, often associated with malignancy.
• Uric acid stones are a known cause of nephrolithiasis but rarely present as complete bilateral ureteral obstruction.

Observation:

• A young, otherwise healthy male presented with severe AKI (creatinine 15.9 mg/dL) after gastroenteritis and diclofenac use.
• Initial workup revealed a left staghorn calculus with mild hydronephrosis; however, complete anuria developed, necessitating hemodialysis.
• CT scan identified obstructing stones in the right ureter, confirming bilateral ureteral blockage.

Findings:

• The patient experienced complete anuria and severe AKI, attributed to multifactorial causes including volume depletion, diclofenac, and bilateral ureteral obstruction.
• Urological surgery successfully relieved the obstruction, leading to post-obstructive diuresis and normalization of serum creatinine.
• Analysis confirmed the obstructing stones were composed of uric acid.

Implications:

• This case highlights the importance of considering bilateral ureteral obstruction in the differential diagnosis of anuria, even in the absence of pain or infection.
• The multifactorial etiology of AKI in this patient underscores the need for comprehensive evaluation and management.
• The successful outcome emphasizes the critical role of timely urological intervention in resolving obstructive uropathy and preserving renal function.