Acute reversible kidney injury secondary to bilateral ureteric obstruction
DOI:
https://doi.org/10.5489/cuaj.726Abstract
Background: Acute reversible kidney injury (ARKI) secondary to
bilateral ureteric obstruction (BUO) is a common urological problem.
Our goals were to describe the etiology, management and
outcomes of such patients identified between 2006 and 2009 and
to compare them with a similar historical study published in 1982.
Methods: Chart review was performed on 49 patients with AKRI
secondary to BUO. ARKI was defined as ≥33% decrease in serum
creatinine after intervention. Those with malignant and benign
causes of obstruction were identified and management and outcome
data were collected.
Results: Of these 49 patients, 83% had BUO secondary to malignancy,
28% of these presenting for the first time. Prevalence of
bladder cancer was increased (p = 0.04) and cervix trended lower
(p = 0.07) compared with the earlier study; prostate cancer was
unchanged (p = 0.51). The average survival was 239 days; 90%
of patients died within a year after presenting with BUO from a
malignant etiology. Compared with the 1982 group, there were
trends towards a decrease in the frequency of retroperitoneal fibrosis
(p = 0.08) and an increase in bilateral ureteric calculi (p = 0.16)
in the benign group.
Conclusions: Patients with ARKI secondary to BUO most likely
have an underlying malignancy, with almost a third of them being
diagnosed for the first time. Prevalence of bladder cancer increased
while cervical cancer trended lower. The cause for the former is
unclear; the latter may be due to aggressive screening. Prostate cancer
remained unchanged despite the widespread implementation of
prostate-specific antigen testing. Patients with an underlying malignancy
do poorly and those with a newly diagnosed malignancy
do worst. Those with ARKI secondary to benign causes did well.
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