Management of extreme azotemia from urinary tract obstruction without dialysis. Clinical correlates and kinetic modeling of the recovery of renal function

Abstract

The recovery of renal function following release of urinary tract obstruction with advanced azotemia determines both the need for emergency dialysis in the early post-obstructive period and the long-term planning for chronic kidney disease management. A man with prostatic cancer who presented with 16 days of anuria and a serum creatinine (Scr) of 42.7 mg/dl but had evidence suggesting residual renal function was managed conservatively and reached a steady-state Scr of 1.6 mg/dl within 84 h of urinary bladder catheterization. Modeling of the decrease in Scr taking into account the decline in the body creatinine pool that existed prior to the release of the obstruction and the accumulation in body fluids of creatinine produced after the release of the obstruction suggested that recovery of the value of glomerular filtration rate corresponding to the steady-state Scr occurred at the release of the urinary obstruction. The case illustrates both the clinical factors that may lead to the decision to postpone dialysis in a patient presenting with extreme obstructive azotemia and a novel method of modeling the recovery of renal function after release of the obstruction.

Ureteric injuries associated with hysterectomy: A five-year experience in treating seventeen ureteric units in nine patients

“…The longest time to present in our series was 2 weeks, unlike the 33 days delay in a bilaterally obstructed patient who had a full renal recovery as reported by Awojobi et al [12] It is well established that the time taken to recognize the injury is the most important morbidity related factor. [13,14] Treatment of distal ureteric injuries depends on the nature of the injury and the time of recognition of the injury. While a deligature may suffice for accidental ligature detected on table, it will not be appropriate treatment when a ureterovaginal fistula develops following delayed presentation as seen in this series hence the ureteroneocystostomy was done.…”