Bilateral Ureteral Lithiasis and Postrenal Acute Kidney Injury: A Rare Complication of Diabetic Ketoacidosis in a Child.

Diabetic ketoacidosis (DKA) is a common initial presentation of type 1 diabetes mellitus (T1DM) in children occurring in up to 40% of cases. DKA can also be associated with severe complications, including nephrolithiasis. We present the case of a 12 years and 8-month-old boy who developed acute kidney injury (AKI) secondary to bilateral urinary lithiasis during the onset of T1DM with DKA. After conventional treatment for DKA, laboratory tests showed increased creatinine and azotemia. 24 hours later, he developed lumbar pain and anuria. Plain radiography, ultrasonography, and computed tomography (CT) revealed bilateral renal calculi and pelvic dilation. An urgent bilateral ascending pyelography with stent placement was performed. Right ureteral stenting was successful, but left stenting failed due to an intramural ureteral anatomical variant; thus, a nephrostomy was performed. Diuresis resumed immediately, and renal function normalized over the following days without permanent impairment. To our knowledge, this is the first reported case of bilateral lithiasis with ureteral stenosis in a pediatric patient with DKA. In patients with severe DKA, we recommend routine monitoring of kidney function with a low threshold for CT imaging whenever there is an unexpected rise in creatinine, oliguria/anuria, or lumbar pain. Early multidisciplinary intervention can promptly relieve postrenal obstruction, prevent permanent renal damage, and improve outcomes.