Acute reversible kidney injury secondary to bilateral ureteric Obstruction

Abstract

Background: Acute reversible kidney injury (ARKI) secondary to bilateral ureteric obstruction (BUO) is a common urological problem. Our goals were to describe the etiology, management and outcomes of such patients identified between 2006 and 2009 and to compare them with a similar historical study published in 1982. Methods: Chart review was performed on 49 patients with AKRI secondary to BUO. ARKI was defined as ≥33% decrease in serum creatinine after intervention. Those with malignant and benign causes of obstruction were identified and management and outcome data were collected. Results: Of these 49 patients, 83% had BUO secondary to malignancy, 28% of these presenting for the first time. Prevalence of bladder cancer was increased (p = 0.04) and cervix trended lower (p = 0.07) compared with the earlier study; prostate cancer was unchanged (p = 0.51). The average survival was 239 days; 90% of patients died within a year after presenting with BUO from a malignant etiology. Compared with the 1982 group, there were trends towards a decrease in the frequency of retroperitoneal fibrosis (p = 0.08) and an increase in bilateral ureteric calculi (p = 0.16) in the benign group. Conclusions: Patients with ARKI secondary to BUO most likely have an underlying malignancy, with almost a third of them being diagnosed for the first time. Prevalence of bladder cancer increased while cervical cancer trended lower. The cause for the former is unclear; the latter may be due to aggressive screening. Prostate cancer remained unchanged despite the widespread implementation of prostate-specific antigen testing. Patients with an underlying malignancy do poorly and those with a newly diagnosed malignancy do worst. Those with ARKI secondary to benign causes did well.

The bladder ran dry: bilateral ureteral obstruction

“…Myriad aetiologies of bilateral ureteral obstruction have been identified in a literature search (box 1). Most patients had an underlying malignant disease 5. Nephrolithiasis was seldom the cause, and when it occurs, the majority of patients have a moderate to severe renal colic and normal urinary output 6.…”

An update on the role of the inflammasomes in the pathogenesis of kidney diseases

“…The composition of crystals varies based on whether they are introduced as drugs or are endogenous to the body [74,75]. It is estimated that 30 % of the AKI cases in children are related to nephrolithiasis [76]; in comparison, the incidence of AKI in adults related to stones appears to be lower, at 1-2 % of cases [77]. Nephrolithiasis is not only a cause of AKI, but it also associated with CKD.…”

Acute and chronic kidney injury in nephrolithiasis

“…Therefore, obstruction is a relatively common cause of community-acquired AKI. However, only 10~12% of obstructive AKI cases were caused by urolithiasis, and these accounted for only about 1–2% of all AKI events [4–6]. Looked at another way, a retrospective Chinese series of 2,073 adult ureteral stones similarly revealed a prevalence of AKI on presentation of only 0.72% [7].…”