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Bilateral Renal Shutdown: A Rare Case of Reflex Anuria Causing Acute Kidney Injury
Paolo Nikolai So1, Runako A Aranha-Minnis1, Donovan Persad1
1Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA, USA.
The American Journal of Case Reports
|February 23, 2026
Summary
Reflex anuria, a rare cause of acute kidney injury (AKI), can occur after pelvic surgery. Prompt recognition and supportive care are crucial for recovery, as demonstrated in this case report.
Area of Science:
- Nephrology
- Urology
- Surgical Complications
Background:
- Reflex anuria is an underrecognized cause of acute kidney injury (AKI).
- It presents as a sudden stop in urine output after urinary tract or adjacent organ irritation/trauma.
- Often overlooked postoperatively due to rarity and diagnostic challenges.
Purpose of the Study:
- To highlight reflex anuria as a cause of AKI after pelvic surgery.
- To emphasize the importance of perioperative renal monitoring.
Main Methods:
- Case report of a 68-year-old woman post-laparoscopic hysterectomy and sacrocolpopexy.
- Diagnostic workup included imaging, cystoscopy with retrograde pyelography, and consideration of other AKI etiologies.
- Renal biopsy was non-diagnostic; treatment focused on supportive care.
Main Results:
- Patient developed anuria and elevated creatinine 24 hours post-surgery.
- No obstruction or injury was found on imaging or cystoscopy.
- Urine output and renal function improved with supportive care, normalizing creatinine within 2 weeks.
Conclusions:
- Reflex anuria is a likely diagnosis given the temporal association with surgery and exclusion of other causes.
- This case underscores reflex anuria as a significant cause of AKI in the context of pelvic surgery.
- Structured renal monitoring in the perioperative period is essential.
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