Unraveling the Cause of Anuria Post Kidney Transplantation by Renal Scintigraphy.

A dynamic renal scintigraphy is widely used after renal transplantation to evaluate transplant function and possible complications. We report the case of a 27-year-old man with persisting anuria after kidney transplantation. A renal scintigraphy using Tc-ethylenedicysteine followed by SPECT/CT of the abdomen was performed showing tracer accumulation in the colon without any activity in the bladder, as a result of ureter reimplantation onto the sigmoid instead of onto the previously reconstructed bladder. Renal scintigraphy identified the cause and localization of the urinary leak, which led to immediate surgical reimplantation of the ureter onto the augmented bladder with onset of diuresis.

Subcapsular Hematoma Causing Anuria After Renal Graft Trauma.

A 67-year-old man presented to the emergency department 22 hours after a trauma to his kidney graft. He was asymptomatic during the first 10 hours, then he became anuric. His serum creatinine level was 2.73 mg/dL (baseline, 0.7 mg/dL), and his hemoglobin concentration was 13.1 g/dL. Computer tomography showed a 4-cm subcapsular hematoma without active bleeding. He underwent urgent decompression of the hematoma, and we did not find any active bleeding or parenchymal laceration. Urinary output had already recovered by the end of surgery without early or late complications. In conclusion, subcapsular hematoma, complicating a traumatic event on a kidney graft, can lead to a progressive parenchymal compression resulting in anuria. So, although in the absence of anemia, such events require urgent surgical decompression. Symptoms cannot be immediate, so all the graft trauma should be investigated with early ultrasound. Little is known in the case of major renal trauma but mildly symptomatic. Probably surgical exploration is better than observation to prevent possible early and late complications such as organ rejection or a Page kidney.

Intraperitoneal urine leak after prostatectomy confirmed by 99mTc-MAG3 renogram.

A 67-year-old patient presented with abdominal pain and distension 2 days after robotic radical prostatectomy for prostate carcinoma. He became anuric, and his serum creatinine level doubled, making IV contrast contraindicated. Abdominal CT without contrast demonstrated hypodense fluid in the peritoneum. Tc-MAG3 renogram detected extravasation of radiotracer from the bladder. Follow-up retrograde cystogram revealed a posterior anastomotic leak. The patient underwent uneventful surgical repair and made a full recovery. This case demonstrated that Tc-MAG3 can prove leak from the urinary tract, particularly helpful in the setting of poor renal function and contraindication to IV contrast.

Urinary ascites and anuria caused by bilateral fungal balls in a premature infant.

A case is reported of anuria and urinary ascites secondary to bilateral ureteropelvic obstruction by fungal balls. Management consisted of bilateral nephrostomy drainage with local irrigation with amphotericin B, and systemic antifungal treatment without surgery. Aspiration by paracentesis was performed for the urinary ascites and continuous drainage through an 8 Fr pig tail catheter for the urinoma. The literature on renal fungus balls in neonates and infants is reviewed.

Routine ultrasound in acute retention of urine.

OBJECTIVE: To evaluate the frequency of urological abnormalities in routine urinary tract ultrasonography (renal and pelvic) in patients with urinary retention secondary to benign prostatic hyperplasia. METHODS: All patients presented to Salmaniya Medical Complex, Bahrain with acute retention of urine secondary to benign prostatic hyperplasia (BPH) in the period between January 2001 and December 2001 were included. The frequency of urological abnormalities, other than BPH, was obtained. RESULTS: One hundred patients were enrolled with a mean age of 67 years. Forty-one patients (41%) had other urological abnormalities. Among these, 3 cases of malignancy were discovered incidentally. A case of renal cell carcinoma, which was completely excised, and 4 cases of bladder tumor, 2 were new cases and 2 were previously known cases of cancer bladder. Other urological abnormalities were renal stones (9 cases), renal cysts (9 cases), hydronephrosis (14 cases) and bladder stones (5 cases). Asymptomatic non-urological abnormalities were gallstones (3 cases), liver cirrhosis (one case) and hepatic hemangioma (one case). Renal impairment was found in 18% of all patients and 80% with hydronephrosis. Four patients had hypoechoic nodules, and all had cancer prostate. CONCLUSION: Significant fraction of patients with acute urinary retention due to BPH have another pathology; although the majority are trivial and it did not influence the immediate management, some are life threatening such as renal cell carcinoma and bladder tumor. Hydronephrosis can be missed if one depends solely on renal biochemistry. Thus, routine evaluation of such patients with pelvic and renal ultrasonography is justified.

Noncontrast computed tomography in obstructive anuria: a prospective study.

OBJECTIVES: To evaluate the role of noncontrast computed tomography (NCCT) in the determination of the cause of obstructive anuria and to compare its accuracy with that of the traditional methods of combined plain abdominal x-ray (KUB) and gray-scale abdominal ultrasonography (US). METHODS: The study included 40 consecutive patients with obstructive anuria. In addition to the routine evaluation, which included history, clinical examination, biochemical profile, KUB, and US, all patients underwent NCCT. The study patients were tested against an age and sex-matched control group that included the normal contralateral kidneys of 57 consecutive patients who underwent KUB, US, and NCCT for acute flank pain during the same study period. The reference standard for the determination of the cause of obstruction was retrograde or antegrade ureterography with or without ureteroscopy or open surgery. The absence of obstruction in the control group was confirmed by nonequivocal normal intravenous urography of the side free of flank pain. Both NCCT and combined KUB and US were compared regarding the sensitivity, specificity, and overall accuracy. RESULTS: The study group had 48 renal units, because obstruction was bilateral in 8 patients and of a solitary kidney in 32. Of the 42 renal units with calculus obstruction, the site of stone impaction was identified in all renal units by NCCT (sensitivity 100%) and in only 25 by combined KUB and US (sensitivity 59.5%)-a significant difference (P = 0.0001). Of the 6 renal units with noncalcular obstruction, both NCCT and US diagnosed the cause of obstruction in 3. The overall sensitivity of NCCT in the determination of the cause of obstructive anuria was 94% and that of combined KUB and US was 58%-a significant difference (P = 0.0001). The specificity of NCCT was not significantly different from that of combined KUB and US (96.5% versus 93%, respectively). The overall accuracy of NCCT was 95% and that of combined KUB and US was 77%-a significant difference (P = 0.0003). CONCLUSIONS: In patients with obstructive anuria, conventional KUB and US could not identify the cause of ureteral obstruction in about 40% of the patients. Under such conditions, NCCT can accurately provide the diagnosis, obviating the need of invasive and expensive diagnostic procedures.

Postrenal anuria after appendectomy in childhood.

An 11-year-old boy suffered from macroscopic haematuria and bilateral flank pain a few days after uneventful appendectomy for retrocaecal appendicitis phlegmonosa. Ultrasonography revealed a complete bilateral distal obstruction of the ureters. Renal failure due to postrenal anuria resolved completely after intravenous antibiotics.

[Abdominal involvement in neurofibromatosis type 1]. / Abdomineller Befall bei Neurofibromatose Type 1.

Neurofibromas are benign tumours that arise from neuroectodermal tissues. They may occur as solitary lesions, or multiple, then referred to as neurofibromatosis, or von Recklinghausen's disease. We report on a 27-year old patient with large involvement of many nerve trunks and plexus (elephantiasis nervosa), responsible for bowel obstruction and anuria.

Self-limiting extravasation in the unused urinary bladder.

Patients being evaluated as potential renal transplant recipients routinely undergo voiding cystourethrography. Eight patients were encountered in whom extraperitoneal extravasation was noted from the region of the ureterovesical junction during voiding (seven patients) or during filling (one patient). Extravasation was bilateral in six patients and unilateral in two. The patients neither experienced symptoms related to the extravasation, required treatment, nor had sequelae. Five of the eight patients have subsequently received renal transplants and their bladders were observed to be normal at surgery. Cystoscopy was also performed in two of these five patients and was unremarkable. After transplantation, these patients' bladders functioned normally and gave rise to no symptoms.

Acute anuric bilateral ureteral obstruction in malignant lymphoma.

Two cases of bilateral ureteral obstruction in malignant lymphoma are reported. In one case, primary infiltration of the ureters by Hodgkin's disease was demonstrated, while in the other the obstruction was due to ureteral compression by enlarged lymph nodes. The diagnostic procedures and the management of such cases are discussed.

Medical imaging of renal diseases-suggested indication for different modalities.

The diagnostic work-up of the urologic patient must be tailored to the presenting symptom complex, carefully selecting from the many modilities available, those most likely to establish the diagnosis and extent of the suspected lesions. Intravenous urography is the most rewarding initial procedure for many presenting symptoms, including suspected masses, pyuria, hematuria, and flank pain. Nuclear imaging is particularly effective in differentiating renal lobulations from true masses, in demonstrating parenchymal scarring in chronic pyelonephritis when the IVP is equivocal, and in assessing the decrease in perfusion and function in obstructive nephropathy when the IVP is indeterminate. It is the preferred procedure for acute renal infarction and acute tubular necrosis and has a greater sensitivity of detection for renal trauma than the IVP. Gallium-67 renal imaging appear helpful in the detection of occult pyelonephritis or interstitial nephritis. However, it cannot differentiate focal acute pyelonephritis from abscess or abscess from neoplasm. Ultrasoneography is the initial procedure of choice in the differentiation of cystic from solid renal masses and in anuria or oliguria. When a kidney fails to visualize by IVP or nuclear imaging, it can confirm or rule out obstruction. In upper tract infections, it may demonstrate renal or perirenal abscess. Although retrograde pyelography is performed less frequently in recent years, it remains extremely useful in confirming and relieving obstructive uropathy and in delineating tumors of the collecting system. Computed tomography effectively demonstrates hydronephrosis, renal abscess, tumors, and cysts and retroperitoneal involvement. More experience is needed to judge the efficiency of "dynamic" CT for the quantification of renal function. Renal angiography remains invaluable as a secondary procedure (as opposed to initial screening) in renal trauma, vascular anomalies, and in renal tumors to delineate the anatomy of the arterial supply and possible renal vein involvement.

Intravenous urography in the management of acute retention.

A retrospective analysis of the frequency of requests for an intravenous urogram (I.V.P.) in men with acute retention of urine showed that this investigation was performed in 82%. In no instance, however, did the urographic findings influence the decision to operate or the type of operation performed. The introduction of a specialised urological service did not reduce the number of I.V.P.s requested because most referrals to the urologist were made after the I.V.P. Patients who had an I.V.P. waited on average 8 days from admission to operation compared with 3-5 days for those who did not. We conclude that no purpose is served by a routine I.V.P. in every male patient admitted to hospital with acute retention of urine.

Oliguria in the incubating neonate. Emergency aortography and urography in neonates using mobile X-ray equipment.

Neonates in incubators underwent umbilical aortography, excretory urography and suprapubic cysto-urethrography using a mobile X-ray machine in the Premature Baby Unit to define the cause of their oliguria. The techniques were easy to perform without endangering the infants by moving them. The radiological findings in the four neonates investigated contributed significantly to the management of their illnesses.