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The Challenges of Diagnosing Nondilated Obstructive Uropathy: A Case Report
Muhammad Asim Shahzad1, Pravir V Baxi1, Roger A Rodby1
1Division of Nephrology, Rush University Medical Center, Chicago, IL, USA.
Canadian Journal of Kidney Health and Disease
|March 31, 2022
Summary
Nondilated obstructive uropathy (NDOU) is a rare cause of acute renal failure. Prompt diagnosis and intervention with ureteral stents can rapidly reverse renal failure, even after prolonged anuria.
Area of Science:
- Nephrology
- Urology
- Oncology
Background:
- Nondilated obstructive uropathy (NDOU) is an uncommon cause of acute renal failure, often associated with malignancies or retroperitoneal fibrosis.
- Its diagnosis can be challenging due to the absence of typical collecting system dilation on imaging.
Observation:
- A middle-aged woman with metastatic breast cancer presented with acute anuric renal failure.
- Initial assessment suggested drug-induced acute tubular necrosis, but retroperitoneal lymphadenopathy raised suspicion for NDOU.
- A retrograde pyelogram revealed bilateral renal pelvis narrowing, confirming the clinical suspicion.
Findings:
- Placement of bilateral ureteral stents resulted in rapid restoration of urine output and reversal of renal failure within 24-48 hours.
- The patient's creatinine levels returned to baseline, allowing discontinuation of hemodialysis.
Implications:
- NDOU requires a high index of suspicion in patients with relevant clinical factors and unexplained acute kidney injury.
- Diagnostic imaging and interventions like ureteral stenting are crucial for timely diagnosis and management of NDOU.
- This case highlights the importance of considering NDOU in the differential diagnosis of renal failure, particularly in cancer patients.
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