[Acute Oliguric Kidney Failure - Gut feeling versus Imaging]

Area of Science:

• Nephrology
• Urology
• Internal Medicine

Background:

• A 68-year-old patient presented with acute kidney injury.
• Diagnosis was complicated by transient renal function recovery and severe proteinuria.
• Imaging did not show hydronephrosis, complicating the diagnosis of postrenal kidney failure.

Purpose of the Study:

• To present a case of acute postrenal kidney failure diagnosed and treated despite the absence of hydronephrosis.
• To highlight the diagnostic and therapeutic challenges in such cases.
• To emphasize the efficacy of bilateral nephrostomy in resolving dialysis-dependent renal failure.

Main Methods:

• Clinical case presentation.
• Diagnostic imaging (repeatedly negative for hydronephrosis).
• Bilateral nephrostomy intervention.

Main Results:

• Bilateral nephrostomy was performed based on clinical history.
• Immediate resumption of diuresis post-intervention.
• Complete recovery of renal function, resolving dialysis dependence.

Conclusions:

• Bilateral nephrostomy can be a life-saving intervention for acute postrenal kidney failure, even without imaging evidence of hydronephrosis.
• Clinical suspicion is crucial for diagnosis and timely intervention.
• This case underscores the importance of considering postrenal obstruction in unexplained acute kidney injury.