As The River Flows: A Case Report of Post Obstructive Diuresis

Area of Science:

• Nephrology
• Urology
• Critical Care Medicine

Background:

• Post obstructive diuresis (PObD) is defined as prolonged urine production (≥200 cc/hr for 2 hrs or >3 L/24hr) after relief of urinary obstruction.
• Pathologic PObD (>48 hrs) can lead to electrolyte deficiencies, hypotension, and shock.
• Pathophysiology involves medullary washout, tubular injury, altered sodium transport, reduced GFR, and poor response to antidiuretic hormone (ADH).

Observation:

• A 79-year-old male with comorbidities presented with invasive bladder cancer and obstructive uropathy.
• An ileal conduit was created, leading to massive urinary diuresis (>48 hrs) and subsequent shock.
• Nephrology consultation initiated a treatment plan focusing on fluid administration, medullary gradient, and ADH response.

Findings:

• A multifaceted therapeutic approach targeting PObD pathophysiology improved the patient's condition.
• Appropriate fluid administration is crucial for managing fluid loss without exacerbating diuresis.
• Addressing underlying pathophysiological mechanisms is significant for treating severe PObD.

Implications:

• This case underscores the need for comprehensive management strategies for severe PObD.
• Tailored treatment targeting specific pathophysiological defects can improve patient outcomes.
• Further research into managing contributive factors beyond fluid regulation is warranted.