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Malignant renal obstruction without dilatation.

B Mohidin1, P Bass2, A Salama3

  • 1MRCP, Core Medical Trainee, University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom.

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Summary
This summary is machine-generated.

A 61-year-old male with anuric acute kidney injury (AKI) was found to have a retroperitoneal mass causing non-dilated obstruction. Prompt decompression via bilateral stents resolved his AKI and eliminated the need for dialysis.

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Area of Science:

  • Nephrology
  • Oncology
  • Radiology

Background:

  • A 61-year-old male presented with anuric acute kidney injury (AKI) and a history of flucloxacillin treatment for cellulitis.
  • Initial investigations including ultrasound ruled out vascular obstruction, but kidney biopsy indicated tubulointerstitial nephritis.

Purpose of the Study:

  • To investigate the cause of anuric AKI in a patient with a suspected retroperitoneal mass.
  • To evaluate the efficacy of therapeutic decompression for non-dilated obstructive uropathy.

Main Methods:

  • Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) scan to characterize the retroperitoneal mass.
  • Bilateral retrograde ureteral stenting for urinary tract decompression.

Main Results:

  • FDG PET-CT revealed a large, FDG-avid retroperitoneal mass causing bilateral, non-dilated ureteral obstruction.
  • Stent insertion led to a 1.6L diuresis and cessation of hemodialysis, indicating successful decompression.

Conclusions:

  • Non-dilated ureteral obstruction should be considered in cases of anuric AKI, especially when malignancy is suspected.
  • Therapeutic trial of decompression is a crucial management step for such conditions.