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Obstructive nephropathy and renal failure not improving after ureteral catheterization
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http://www.kidney-international.org © 2007 International Society of Nephrology
Kidney International (2007) 72, 660. doi:10.1038/sj.ki.5002237
Obstructive nephropathy and renal failure not improving after ureteral catheterization AE Sirvent1, R Enríquez1, JA Gallego2 and L De Paz3 1Nephrology Section, Hospital General Universitario de Elche, Elche, Spain; 2Diagnostic Radiology Service, Hospital General Universitario de Elche,
Elche, Spain; and 3Urology Service, Hospital General Universitario de Elche, Elche, Spain Correspondence: AE Sirvent, Nephrology Section, Hospital de Elche, Camí de l´Almazara S/N, E-03203 Elche (Alicante), Spain. E-mail: [email protected]
Figure 1 | Non-contrast-enhanced computed tomography scan of right kidney. Coronal view (left) and sagittal view (right). Right proximal collecting system perforation by double-J catheter. Extraureteral catheter position is noted anterosuperior to the kidney in the hepatorenal space (Morison’s pouch).
Figure 2 | Non-contrast-enhanced computed tomography scan of left kidney. Coronal view (left) and sagittal view (right). Right proximal collecting system perforation by double-J catheter. The double-J catheter is traversing the upper pole of the kidney with its cranial tip in the perirenal fat of the left upper abdominal quadrant.
A 75-year-old patient with a history of hypertension and kidney stones was admitted to another hospital with bilateral renal colic. Renal imaging (abdominal X-ray, plain and ultrasound) revealed bilateral hydronephrosis due to radiolucent calculi. Two double-J ureteral catheters were placed, but the patient remained anuric and was subsequently referred to our hospital. Laboratory tests were notable for a serum creatinine level of 6 mg per dl and a potassium level of 8 mequiv. per liter with electrocardiographic changes for which the patient received emergent hemodialysis. An abdominal computed tomography scan showed bilateral hydronephrosis and perforation of the collecting system by both catheters with their tips outside the
pelvis of the kidney (Figures 1 and 2). With cystoscopy, only the left ureteral catheter was able to be replaced, because of marked edema of the right ureter. Urine output immediately improved along with improvement in the patient’s renal function (creatinine 1.6 mg per dl). A right percutaneous nephrostomy was subsequently performed, followed by surgical extraction of the ureteral catheter. Persistent oliguria after ureteral catheterization for acute obstructive nephropathy is a cause for concern. Hemodynamic compromise, if present, should be corrected. Iatrogenic complications may rarely lead to persistent oliguria, as was demonstrated in this case.
660
Kidney International (2007) 72
http://www.kidney-international.org © 2007 International Society of Nephrology
Kidney International (2007) 72, 660. doi:10.1038/sj.ki.5002237
Obstructive nephropathy and renal failure not improving after ureteral catheterization AE Sirvent1, R Enríquez1, JA Gallego2 and L De Paz3 1Nephrology Section, Hospital General Universitario de Elche, Elche, Spain; 2Diagnostic Radiology Service, Hospital General Universitario de Elche,
Elche, Spain; and 3Urology Service, Hospital General Universitario de Elche, Elche, Spain Correspondence: AE Sirvent, Nephrology Section, Hospital de Elche, Camí de l´Almazara S/N, E-03203 Elche (Alicante), Spain. E-mail: [email protected]
Figure 1 | Non-contrast-enhanced computed tomography scan of right kidney. Coronal view (left) and sagittal view (right). Right proximal collecting system perforation by double-J catheter. Extraureteral catheter position is noted anterosuperior to the kidney in the hepatorenal space (Morison’s pouch).
Figure 2 | Non-contrast-enhanced computed tomography scan of left kidney. Coronal view (left) and sagittal view (right). Right proximal collecting system perforation by double-J catheter. The double-J catheter is traversing the upper pole of the kidney with its cranial tip in the perirenal fat of the left upper abdominal quadrant.
A 75-year-old patient with a history of hypertension and kidney stones was admitted to another hospital with bilateral renal colic. Renal imaging (abdominal X-ray, plain and ultrasound) revealed bilateral hydronephrosis due to radiolucent calculi. Two double-J ureteral catheters were placed, but the patient remained anuric and was subsequently referred to our hospital. Laboratory tests were notable for a serum creatinine level of 6 mg per dl and a potassium level of 8 mequiv. per liter with electrocardiographic changes for which the patient received emergent hemodialysis. An abdominal computed tomography scan showed bilateral hydronephrosis and perforation of the collecting system by both catheters with their tips outside the
pelvis of the kidney (Figures 1 and 2). With cystoscopy, only the left ureteral catheter was able to be replaced, because of marked edema of the right ureter. Urine output immediately improved along with improvement in the patient’s renal function (creatinine 1.6 mg per dl). A right percutaneous nephrostomy was subsequently performed, followed by surgical extraction of the ureteral catheter. Persistent oliguria after ureteral catheterization for acute obstructive nephropathy is a cause for concern. Hemodynamic compromise, if present, should be corrected. Iatrogenic complications may rarely lead to persistent oliguria, as was demonstrated in this case.
660
Kidney International (2007) 72