Xiang Xinyu, Wei Xiaobao, Miao Jiayi, Sun Meng, Cao Wei, Zhao Baiqiao, Zhang Yiwen, Wei Juanyu, Zhu Lin, Zhang Yongping, Zhang Ting, Zhang Liyuan
Department of Nephrology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China.
Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, China.
Front Oncol. 2025 Sep 1;15:1586443. doi: 10.3389/fonc.2025.1586443. eCollection 2025.
Postrenal obstruction is a rare but reversible cause of acute kidney injury (AKI), often underrecognized when hydronephrosis is mild or absent. We present a 55-year-old woman with gastric cancer who developed severe AKI requiring hemodialysis. Initial non-contrast abdominal CT revealed only mild bilateral hydronephrosis without obvious ureteral obstruction. Given these subtle radiologic findings and a history of chemotherapy and NSAID exposure. Initially, a multidisciplinary team attributed the AKI to intrinsic renal causes. Subsequent renal biopsy revealed only minimal glomerular changes, insufficient to explain the degree of renal dysfunction. Despite supportive care, her renal function continued to decline. Further urological evaluation led to the placement of bilateral ureteral stents, which resulted in a prompt increase in urine output and improvement in serum creatinine. However, rapid restenosis occurred within four days, necessitating percutaneous nephrostomy. This two-step intervention restored renal function and improved short-term prognosis. This case underscores the diagnostic challenge of postrenal AKI in malignancy, particularly when imaging findings are subtle. Peritoneal carcinomatosis may cause ureteral encasement through mechanisms such as inflammation, fibrosis, and lymphatic disruption, often without significant collecting system dilation. Timely urologic intervention, guided by clinical judgment and supported by multidisciplinary collaboration, is critical to improving outcomes in such atypical presentations.
肾后性梗阻是急性肾损伤（AKI）的一种罕见但可逆转的病因，当肾积水较轻或不存在时，常常未被充分认识。我们报告一名55岁患胃癌的女性，她发生了严重的AKI，需要进行血液透析。最初的非增强腹部CT仅显示轻度双侧肾积水，无明显输尿管梗阻。鉴于这些细微的影像学表现以及化疗和使用非甾体抗炎药的病史，起初，一个多学科团队将AKI归因于内在的肾脏病因。随后的肾活检仅显示轻微的肾小球改变，不足以解释肾功能障碍的程度。尽管给予了支持治疗，她的肾功能仍持续下降。进一步的泌尿外科评估导致放置了双侧输尿管支架，这使得尿量迅速增加，血清肌酐水平改善。然而，四天内迅速发生了再狭窄，需要进行经皮肾造瘘术。这两步干预恢复了肾功能并改善了短期预后。该病例强调了恶性肿瘤中肾后性AKI的诊断挑战，尤其是当影像学表现细微时。腹膜癌转移可能通过炎症、纤维化和淋巴管破坏等机制导致输尿管包绕，通常没有明显的集合系统扩张。在临床判断的指导下并通过多学科协作支持进行及时的泌尿外科干预，对于改善此类非典型表现的预后至关重要。
