Non-dilated obstructive uropathy – an unrecognized cause of acute renal failure in hospitalized US patients: three case reports seen over 6 months in a northwestern Wisconsin Nephrology practice

Abstract

The syndrome of non-dilated obstructive uropathy (NDOU) and acute renal failure (ARF) is well reported. However, the literature suggests that this syndrome is rare, accounting for less than 5% of cases of urinary obstruction. Our recent experience with three cases of NDOU seen within a space of months implies otherwise. Between March 2009 and October 2009, in a small Midwestern American town Nephrology practice, we successfully managed three cases of NDOU. They all presented with newly symptomatic ARF. Renal imaging revealed no dilatation in both kidneys in one, only unilateral dilatation in the second, and dilatation was absent in a single functioning kidney in the third. They comprised of two males and one female, mean age 61 years (peak creatinine: 320-880 μmol/L). Despite the absence of dilatation on renal imaging, strong suspicion for NDOU led to decompression procedures with prompt recovery of kidney function in all three patients -two required percutaneous nephrostomy tube placements and/or ureteric stents and one responded to simple Foley catheter drainage. One required temporary hemodialysis. We submit that NDOU may be more common than previously speculated. A high index of suspicion is warranted as significant renal salvage can often be achieved by timely decompression procedures.

Pyelonephritis and obstructive uropathy: a case of acute kidney injury

“…Five days later, a repeat scan was undertaken and mild dilation was seen—thus ureteric stenting was performed. A further two cases of non-dilated obstructive uropathy occurring on a background of malignancy are presented by Onuigbo et al ,21 the first being a 56-year-old man who was eventually diagnosed with a urothelial carcinoma and the second, a 59-year-old woman with a history metastatic uterine cervical adenocarcinoma. Leong et al 22 presented a case in a 31-year-old man with a history of ulcerative colitis, who presented in a similar way to the case presented here, with flank pain, dehydration and sepsis.…”

“…This may take the form of CT scanning (to demonstrate tumours),19 or antegrade pyelography 19 21. Multiple factors predisposing to AKI may be present in any one patient 5.…”

Is Postrenal Acute Renal Failure Possible in the Absence of Hydronephrosis?

“…Therefore, in anuria, especially zero urine output, postrenal ARF must be ruled out even if hydronephrosis delinea (7). The syndrome of non-dilated obstructive uropathy (NDOU) and ARF was previously described (8). The most suitable imaging technique for diagnosis of NDOU is non-contrast spiral abdominal CT (9).…”

Loin pain and a normal CT KUB: what to do?

“…A patient with ureteric obstruction will normally demonstrate hydronephrosis on a CT scan. Non‐dilated obstructive uropathy is a rare cause of obstructive uropathy but has been reported in the context of dehydration, renal failure and in patients with known pelvic malignancy . A mercapto acetyl triglycine (MAG3) renogram can assess the drainage of the kidney in patients with sufficient renal function.…”