SHM Converge Scientific Abstract ePoster Gallery-An Unusual Presentation of Obstructive Renal Failure Due to Peritoneal Carcinomatosis

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This case describes a 56-year-old woman with triple-negative breast cancer and known peritoneal carcinomatosis who presented with three days of oliguria, severe acute kidney injury (creatinine 10.0 mg/dL from baseline 0.8), and hyperkalemia (K 7.1 mmol/L). She had recently received carboplatin/gemcitabine, but denied pain, urinary symptoms, recent illness, or decreased intake.<br /><br />She was initially treated with emergent hemodialysis. Evaluation showed a decompressed bladder on ultrasound and only mild, unchanged bilateral hydronephrosis on CT, which lowered suspicion for postrenal obstruction and raised concern for chemotherapy-related intrinsic kidney injury. A Foley catheter and diuresis did not improve urine output, and creatinine continued to rise, requiring ongoing intermittent hemodialysis. Kidney biopsy suggested ischemic acute tubular injury/acute tubular necrosis.<br /><br />Because of persistent concern for occult distal obstruction, bilateral ureteral stents were placed on hospital day 5. This led to immediate improvement in urine output and renal function, with discharge on day 7 at creatinine 1.76 mg/dL. However, she was readmitted two weeks later with recurrent AKI despite stents remaining in place and imaging again showing only mild hydronephrosis. She ultimately required bilateral percutaneous nephrostomy tubes.<br /><br />The case highlights non-dilated obstructive uropathy (NDOU), a form of malignant urinary obstruction in which imaging may show little or no hydronephrosis despite significant postrenal failure. In cancer patients, especially those with peritoneal carcinomatosis, obstruction may result from impaired ureteral peristalsis, fibrosis, or extrinsic compression. Recognizing NDOU is critical because delayed diagnosis can lead to severe renal failure, while timely decompression can rapidly reverse kidney injury.

Asset Subtitle

Nikki J. Kasal

Meta Tag

Author List Farrah Malik, Khanh T. Nguyen, Nikki J. Kasal

Category Clinical Vignettes

Concept Malignant Urinary Obstruction

Concept Acute Kidney Injury

Concept Non-dilated Obstructive Uropathy

Concept Ureteral Obstruction

Concept Obstructive Renal Failure

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Nikki J. Kasal

Track Adult

Keywords

triple-negative breast cancer

peritoneal carcinomatosis

acute kidney injury

hyperkalemia

hemodialysis

carboplatin gemcitabine

non-dilated obstructive uropathy

ureteral stents

percutaneous nephrostomy

malignant urinary obstruction

Malignant Urinary Obstruction

Acute Kidney Injury

Non-dilated Obstructive Uropathy

Ureteral Obstruction

Obstructive Renal Failure