Yap Ernie, Salifu Moro, Ahmad Tahir, Sanusi A, Joseph Anthony, Mallappallil Mary
State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
Case Rep Nephrol. 2019 Feb 27;2019:4903693. doi: 10.1155/2019/4903693. eCollection 2019.
Acute kidney injury due to urinary tract obstruction invariably suggests lower urinary tract obstruction or bilateral ureteric obstruction since obstruction of a single kidney while the contralateral kidney is normal and not obstructed would not cause a perceptible rise in creatinine. Assuming a total body volume of 42 L, 70 kg male that generates approximately 1400 mg of creatinine daily (20 mg/kg/day) who has complete urinary tract obstruction would experience a 3.33 mg/dL per day increase in serum creatinine. Thus, for an individual who had prior normal renal function and who presents with a creatinine of 30 mg/dL, one could surmise that the obstructive pathology had lasted at least 10 days. However, the rise in serum creatinine is a poor marker of renal injury and subsequent prognosis. Urinary tract obstruction leading to AKI can be due to a variety of causes, and its management is tailored to the underlying etiology. This case series describes the varied clinical course of four patients at our center who experienced AKI from atypical causes of obstructive uropathy. Current and future diagnostic modalities and caveats in the treatment of this disease entity are also discussed.
由于尿路梗阻导致的急性肾损伤总是提示下尿路梗阻或双侧输尿管梗阻，因为在对侧肾脏正常且未梗阻的情况下，单个肾脏的梗阻不会导致肌酐明显升高。假设一名70公斤男性总体液量为42升，每天产生约1400毫克肌酐（20毫克/公斤/天），若发生完全性尿路梗阻，其血清肌酐每天会升高3.33毫克/分升。因此，对于一名既往肾功能正常且肌酐水平为30毫克/分升的患者，可以推测梗阻性病变至少持续了10天。然而，血清肌酐的升高并不是肾损伤及后续预后的良好指标。导致急性肾损伤的尿路梗阻可能由多种原因引起，其治疗需根据潜在病因进行调整。本病例系列描述了我们中心4例因非典型梗阻性肾病病因导致急性肾损伤患者的不同临床过程。同时还讨论了该疾病实体当前和未来的诊断方法及注意事项。
