Dynamic Renal Tract Obstruction Due to Uterine Prolapse and the Potential Role of Erect MAG3 Imaging

Uterine prolapse is a common pathology and can be an insidious cause for hydronephrosis and end stage renal failure. We report a case of progressive chronic kidney disease, secondary to uterine prolapse. Her initial pelvic exam, cystoscopy and functional testing demonstrated no obvious aetiology of obstruction when she was tested in the supine position. Repeat testing in the erect position demonstrated a urinary tract obstruction as the cause for her progressive chronic kidney disease. This case highlights that there may be a role for erect functional imaging as an adjunct in the diagnostic pathway for dynamic extrinsic obstructive nephropathy, when exam and standard supine imaging are non-diagnostic. Timely and accurate diagnosis was associated with avoidance of dialysis initiation and with significant recovery of renal function.