A CASE OF AN EXPLODING KIDNEY

A CASE OF AN EXPLODING KIDNEY

Pamela Wu^1,2, Tracy Li^1,2, Jeffrey Wong^1,2, Stephen Timothy Spicer^1,2, Bruce Cleland<sup>1

1</sup>Department of Nephrology, Liverpool Hospital, Liverpool, New South Wales, Australia
²South Western Sydney Clinical School, UNSW, Liverpool, New South Wales, Australia

Abstract

Background
Renal calyceal ruptures are categorised by traumatic and non-traumatic causes. Common non-traumatic causes include progressive carcinoma or ureteric calculi. This is a rare occurrence with only several cases in literature.

Case Report
We report a case of an 84-year-old woman who presented with a spontaneous non-traumatic right renal calyceal rupture. She initially presented with a decreased level of consciousness and delirium without flank pain or tenderness. Prior to her presentation, she had received four days of cephalexin for a urinary tract infection in the community. She had an associated acute kidney injury secondary to Escherichia coli urosepsis and her creatinine peaked at 264μmol/L from a baseline of 74 μmol/L.

Initial renal ultrasound revealed bilateral mild to moderate hydronephrosis and a small amount of perinephric fluid. On further contrast-enhanced CT imaging, it revealed a very extensive leak of contrast adjacent to the right ureter and right renal pelvis into the right retroperitoneum. There was also a large volume of excreted urine and contrast present in the right retroperitoneum. A right nephrostomy tube was inserted by interventional radiology to decompress the obstruction, as the patients’ comorbidities and poor functional baseline in a high-level care nursing home precluded her from undergoing surgical decompression. A week later, interventional radiology also inserted a right antegrade ureteric stent, with subsequent removal of nephrostomy a day later. Her renal function returned to normal after treatment.

Conclusions
Spontaneous renal calyceal rupture should be considered in geriatric patients with non-specific symptoms and associated acute kidney injury. Obstructive causes of acute kidney injury should be promptly excluded so that timely treatment can be facilitated to decompress ureteric obstruction and reverse acute kidney injury.

Biography

Bio to come