Nondilated obstructive acute renal failure: diagnostic procedures and therapeutic management.

Abstract

We examined 80 patients with acute obstructive anuria by ultrasound (US). Four of the 80 patients did not have dilatation of the urinary tract. In all four cases, antegrade pyelography guided by real-time US demonstrated urinary tract obstruction after the four patients had experienced 4, 5, 8, and 34 days of anuria, respectively. Diuresis occurred as a result of percutaneous nephrostomy in all four cases. Three of the patients were successfully treated by percutaneous techniques alone. Our findings demonstrate that even a complete and long-term obstruction of the urinary tract does not necessarily induce dilatation in the upper part of the tract. In such cases, only the direct opacification of the urinary tract can help confirm that the obstruction is present. Even in the absence of dilatation, antegrade pyelography guided by real-time US is a possible diagnostic method and can be the first step in the performance of percutaneous nephrostomy.

Anuric, obstructive uropathy in the absence of obvious radiological evidence of obstruction

“…9 Ultrasonography is commonly used in the diagnosis of calicael obstruction, however, dilatation is sometimes not seen with ultrasonography. 1,3,6,23 This might be due to poor vision of renal pelvis and ureter, which are often obscured by bowel gas. False negative might also be caused by dehydration resulting in a low urine output and thus lack of dilatation, 23 which was seen in this patient during the initial ultrasonography.…”

“…1 Bilateral ureteric obstruction because of external compression caused by retroperitoneal fibrosis or malignant disease account for 60% of these cases. [1][2][3][4][5][6] We report an unusual case of acute renal failure secondary to non-dilated bilateral ureteric obstruction from stone disease.…”

Doppler sonography in the diagnosis of urinary tract obstruction by stone

“…10 But both IVU and sonography have limitations in determining the functional significance and degree of obstructions and the cause of hydronephrosis. 3,4,11,22,30,31 We found hydronephrosis in 64% of patients (18 patients) with grayscale sonography. The sensitivity and specificity of this modality for renal obstruction were 64% and 100%, respectively; the sensitivity value is lower than that in other reports.…”

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

“…Between 4% and 5% of patients with obstructive uropathy are estimated to demonstrate the syndrome of NDOU. 9,10 On the contrary, we encountered three cases of NDOU in a space of just over 6 months in a small town Midwestern American Nephrology practice. We would therefore like to submit that the syndrome of NDOU may not be as uncommon as currently speculated, after all, and that it may be frequently missed by unsuspecting clinicians and consequently goes undiagnosed.…”