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Bilateral retrograde pyelography leading to anuria
A Mallya1, V S Karthikeyan1, C M S Manohar1
1Department of Urology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru 560002, Karnataka, India.
The National Medical Journal of India
|December 12, 2019
Summary
Retrograde pyelography (RGP) can cause acute kidney injury, especially when performed bilaterally. This case highlights the risk of renal shutdown following bilateral RGP, emphasizing the need for caution.
Area of Science:
- Nephrology
- Urology
- Radiology
Background:
- Retrograde pyelography (RGP) is an imaging technique used to evaluate the urinary collecting system.
- It is often employed when intravenous contrast studies are contraindicated due to renal insufficiency or previous adverse reactions.
- The procedure involves instilling contrast medium directly into the ureters and renal pelvis.
Observation:
- A 65-year-old male with a history of stroke and hypertension presented with persistent hematuria.
- Following bilateral RGP for evaluation of malignant urine cytology, the patient experienced acute renal shutdown.
- Serum creatinine levels significantly elevated post-procedure, necessitating hemodialysis.
Findings:
- The patient developed anuria and acute kidney injury immediately after bilateral retrograde pyelography.
- Despite no evidence of hydroureteronephrosis on ultrasound, renal function deteriorated rapidly.
- Renal function eventually stabilized after supportive care and hemodialysis.
Implications:
- Bilateral retrograde pyelography, though diagnostically useful, carries a risk of acute kidney injury.
- This case underscores the importance of cautious application of RGP, particularly in bilateral procedures.
- Further evaluation of routine stenting protocols following RGP may be warranted.
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