Dialameh H. et al., 2021: Symptomatic kidney stones in an anuric patient on dialysis: A case report.
Dialameh H, Namdari F, Mahalleh M, Lotfi M, Ali Z.
Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Aja University of Medical Sciences, Tehran, Islamic Republic of Iran.
Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Abstract
Introduction: Renal colic is a colicky-type of flank pain that can commonly be presented in patients undergoing dialysis especially if they are anuric considering the fact that there are multiple controversies and little published experience on this topic, we found it very important to report this case. We also aimed to increase awareness and emphasize the importance of renal colic in anuric patients on dialysis.
Case description: We herein report a case of a 42-year old man with a chief complaint of bilateral colic flank pain, He had developed end stage renal disease due to ADPKD and was on hemodialysis since the past 5 years. Previously, he went through a series of workup but was left undiagnosed. Abdomen-pelvic and chest CT scan without contrast was performed showing bilateral renal pelvic stones and some nephrocalcinosis in both kidneys. bilateral ureteroscopy was performed and bilateral DJ was installed for a total of 6 weeks and extracorporeal shock wave lithotripsy was done. With prompt diagnosis, the patient was pain free and stone free before discharge. The patient is also reported to be stone free 6 months after the procedure.
Conclusion: Patients on dialysis are still capable of forming symptomatic renal tract stones even if they are anuric.
Urologia. 2021 Aug 4:3915603211035927. doi: 10.1177/03915603211035927. Online ahead of print. PMID: 34346240
Comments 1
There are some interesting lessons that can be learnt from this case report.
Urinary tract stones can form in anuric patients.
The mechanism behind this process is poorly understood, but precipitation of salts in protein matrix is a possible explanation.
Colicky pain can occur in anuric patients even when no stones are demonstrated.
The lack of endoscopic equipment in the authors’ department forced them to carry out SWL (good or bad??) after which the patient became stone-free.
Surprising conclusion:
Despite this successful outcome of SWL the authors claim that he primary treatment for a patient like this should be bilateral retrograde intrarenal surgery!?
Hans-Göran Tiselius