Related Experiment Video
Updated: Jul 11, 2025
Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection
Published on: October 12, 2017
OBSTRUCTIVE UROPATHY FROM BILATERAL URETERIC CALCULI IN AN INFANT WITH DIARRHOEA DISEASE
1Department of Paediatrics, Gombe State University and Federal Teaching Hospital, Gombe.
Insights
Bilateral ureteric calculi in an infant with diarrhea and dehydration led to obstructive uropathy and acute kidney injury. Prompt surgical intervention and fluid management were crucial for recovery.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Surgery
Background:
- Urolithiasis (kidney stones) is uncommon in young children and Sub-Saharan Africa.
- While metabolic issues cause 50% of cases, dehydration and urinary stasis are also implicated.
- This case highlights a rare instance of bilateral ureteric calculi in an infant.
Observation:
- An 8-month-old infant presented with severe diarrhea, vomiting, fever, and generalized swelling, indicating dehydration and acute kidney injury.
- Clinical examination revealed ascites, respiratory distress, hypertension, and significantly elevated creatinine and urea levels.
- Imaging confirmed bilateral ureteric calculi causing hydroureteronephrosis and nephritis.
Findings:
- The infant underwent bilateral ureteric exploration, ureterolithotomy, and stenting to relieve the obstruction.
- Post-surgery, urine output improved, and serum creatinine and urea levels progressively decreased.
- The patient was discharged and is undergoing follow-up in pediatric nephrology and urology clinics.
Implications:
- A high index of suspicion for obstructive uropathy is recommended in infants with diarrhea, dehydration, and acute kidney injury.
- Early diagnosis and surgical management of ureteric calculi are vital in pediatric cases.
- This case underscores the importance of considering urolithiasis in the differential diagnosis of severe dehydration and AKI in infants.
Introduction:
Urolithiasis is the presence of mineral deposits in the urinary tract. It is rare in under-5 children and in Sub-Saharan Africa. Although metabolic abnormality is implicated in 50% of cases, infection, decreased urine volume and flow (dehydration state) have been implicated. We report a case of bilateral ureteric calculi in an infant with diarrhoea disease and dehydration.
Case Report:
A.S, is an 8-month-old male with prolonged loose, large-volume stool, large-volume vomiting, high-grade fever, body weakness, and peri-orbital swelling that progressed to generalized body swelling and absent urine for 2 days. He was conscious, afebrile (36.90C), pale with anasarca. Had distended abdomen with ascites. Dyspnea, coarse crepitation, and hypoxemia. Tachycardia (PR -180/min) Hypertensive (BP - 125/79mmHg). PCV - 20%, WBC - 24,000/l, platelet - 110,000/l. Creatinine (1030 umol/l), Urea - 30mmol/l, Multi drug resistant E.Coli. Bilateral Grade II nephritis, hydro-uretero-nephrosis, right pelvi-ureteric and left vesico-ureteric junction calculi. Managed for Diarrhoea disease complicated with Bilateral Obstructive uropathy secondary to Bilateral Ureteric Calculi. Had bilateral open ureteric exploration, ureterolithotomy, Stenting, intraoperative transfusion, antibiotics, analgesics, and IVF. 24-hr post-surgery: urine output (3.26ml/kg/hr): right stent (210ml), left stent (423ml) while urethral catheter (150ml), 742umol/l, Urea: 26mmol/l 48-hr post-surgery: Urine output 5.1ml/kg/hr (1224ml/24hr); Cr: 424umol/l, Urea: 16mmo/l 5 days post-surgery: Urine output 3.1ml/kg/hr (725ml/24hr); Cr: 47umol/l, Urea: 4.6 mmo/l, Patient was discharged home and currently on follow-up in paediatric nephrology and urology clinics.
Conclusion:
A high index of suspicion of obstructive uropathy in children with diarrhoea disease, and dehydration, who have developed acute kidney injury is recommended.
Related Concept Videos
01:28Urinary Tract Calculi V: Nursing Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:28Urinary Tract Calculi I: Introduction
01:20Disorders of the Urinary System
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:30Urinary Tract Calculi III: Medical Management