Obstructive acute kidney injury with maintenance of diuresis: a case of ureter bifidity
Abstract
Percutaneous kidney biopsy in transplanted kidneys remains an essential and commonly performed procedure required for diagnostic and prognostic information. Hemorrhage is the main complication of renal graft biopsy.
We report a case of a 47-year-old caucasian woman admitted to perform an ultrasound (US)-guided biopsy of the renal graft. Six hours later, she presented with macroscopic hematuria which improved after urethral catheterization and intravenous hydration. However the hematuria reappeared associated with anemia and worsening of the serum creatinine value. The US study, revealed hydronephrosis with high Doppler derived renal resistive index compatible with clot obstruction. Despite the vesical lavage with drainage of several clots, the patient rapidly progressed to hemorrhagic shock with worsening of renal function. Pelvic computed tomography (CT) revealed calyx and pelvis duplicity and ureter bifidity which merged into a single ureter and inserted into the right anterolateral wall of the bladder. The inferior ureter was enlarged due to an obstructive clot.
Most acute obstructive uropathies are associated with significant pain or the abrupt diminution of urine flow. The presence of ureter bifidity in the CT study explained the maintenance of significant diuresis despite obstruction, located only to the lower ureter but with sufficient functional impact to condition acute kidney injury (AKI).
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