Pyelonephritis and obstructive uropathy: a case of acute kidney injury

Abstract

We present a case of a man in his late 50s with a history of metastatic prostate carcinoma requiring bilateral ureteric stenting. He was admitted with increasing confusion and lethargy. He was diagnosed with sepsis and an acute kidney injury (AKI). Clinical suspicions of an obstructive component to his AKI were not confirmed by an ultrasound scan, which showed a unilateral hydronephrosis unchanged from a scan 1 month previously. A nephrostomy was performed, and frank pus aspirated. The patient's clinical state improved steadily thereafter. Patients who are dehydrated, or who have suffered from malignant or fibrotic processes affecting the retroperitoneum, may present with urinary obstruction without a corresponding increase in urinary tract dilation. Additionally, there must be a suspicion of pyonephrosis in a symptomatic patient with known hydronephrosis. Clinicians should be aware that clinical suspicions of urinary obstruction not demonstrated on ultrasound scanning require further investigation.

The Challenges of Diagnosing Nondilated Obstructive Uropathy: A Case Report

“…A small number of cases have been reported in conjunction with conditions such as nephrolithiasis and pyelonephritis. 6 In most of these clinicopathological conditions, imaging with antegrade/retrograde pyelogram will make the diagnosis. In a few case reports, NDOU was not evident even with contrast renography, and surgical exploration with nephrostomy tube placement was required to make the diagnosis.…”

A case of pyelonephritis due to ureteral obstruction caused by complete uterine prolapse

“… 1 POP leads to obstructive uropathy with renal dysfunction that requires treatment with a pessary or ureteral stent. Although cases of pyelonephritis caused by obstructive uropathy resulting from prostate cancer have been reported, 2 no reports of pyelonephritis due to obstructive uropathy caused by uterine prolapse are available. This report presents the case of a patient with pyelonephritis due to obstructive uropathy caused by uterine prolapse.…”