Clinical Case Reports

Biography

Biography: Mohamed Abbasy

Abstract

Introduction: We present a case of bilateral ureteric colic causing anuric acute renal failure. Bilateral ureteric colic resulting in acute renal failure is not an unheard of presentation. However in our case the patient had only 3mm calculi making our case unique. Background: Bilateral renal calculi are an uncommon cause of acute kidney injury (AKI). Obstructing ureteroliths rarely lead to AKI without some underlying renal disease or anatomic abnormalities, such as a solitary kidney or horseshoe kidney. The incidence of a unilateral uterovesicular junction obstruction secondary to a stone is reported at 20% in the literature. However, there are very few case reports in the urology, nephrology or emergency medicine literature regarding the incidence of bilateral ureteric calculi. Cases of bilateral ureteric calculi are uncommon and cases resulting in AKI and anuria are extremely rare. Case Presentation: A 30 year old male who was otherwise healthy presented with bilateral colicky flank pain for 4 days and started to develop macroscopic haematuria. After proper pain management in the emergency department, the patient was found to have a raised serum creatinine (152 µmol per L). A CT scan was performed showing two 3 mm calculi in the left and right proximal ureters. Ultrasound showed moderate left hydroureteronephrosis and mild right hydroureteronephrosis. Due to the relatively small sizes of the stones involved and the clinical picture of the patient, he was planned for medical expulsive therapy. Surprisingly the patient developed complete anuria for 2 days and represented to the ED with a serum creatinine of 843 µmol/L. Bilateral double J stents were placed and urgent ureteroscopy was done for the patient. Following treatment, his condition significantly improved and his renal function returned back to normal within 4 days. Discussion: Even small bilateral stones can result in acute kidney injury.