Anuria and acute kidney injury: an uncommon case of bilateral synchronous ureteric calculi

NMUH Staff Publications

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Nephroureterolithiasis is the third most common pathology of the urinary tract affecting 12% of male and 6% of female whites, with a recurrence rate of 50% within 10 years. The incidence of unilateral ureteric calculi is 20%; however, the presentation of bilaterial synchronous ureteric calculi is uncommon. A 37 year old man presented with left loin pain and the absence of urine output. Fifteen years previously, he had a percutaneous nephrolithotomy. Examination revealed left flank tenderness. Serum blood markers demonstrated an acute kidney injury with a creatinine of 307 umol/L and estimated glomerular filtration rate of 20 mL/min per 1.73 m2. An urgent non contrst computer tomography kidneys ureter and bladder (CTKUB) illustrated bilateral hydronephroureterosis caused by a 12 x 5 mm calculus in the right distal ureter and a 4 x 4 mm calculus in the left distal ureter. Emergency bilateral retrograde uretic stenting was performed to allow for decompression and drainage. Four weeks later he returned for bilateral rigid ureteroscopy and laser stone fragmentation. The encrusted stents were crushed with forceps before removal and replacement. The case is uncommon for 2 reasons: anuria in a young patient and bilaterial synchronous ureteric calculi. It is important to keep this as a differential diagnosis for an obstructive uropathy causing acute kidney injury as it is a urological emergency requiring prompt specialist referral to preserve renal function.