Asynchronous Cortical Necrosis after Bilateral Nephrostomy

Hemodialysis Admission Right nephrostomy 150 15 Left nephrostomy ιoo ιo 50 L·o υ 0· 500 Dear Sir, Renal cortical necrosis is commonly bilateral and described as a manifestation of disseminated intravascular coagulation (DIC). Hydronephrosis [1–3] and renal artery stenosis [4] have been reported to protect the kidney from being affected by DIC. It is possible that DIC coincides with hydronephrosis, especially in patients with disseminated cancer in the retroperitoneal area. The following case with bilateral hydronephrosis secondary to metastatic ureteral obstruction is such a case. Case Report A 75-year-old woman was admitted on November 18, 1985, because of anuria caused by bilateral ureteral obstruction. Urine obtained later through nephrostomy showed no evidence of bacterial infection. Laboratory data revealed a serum creatinine of 10.1 mg/dl, urea nitrogen (BUN) 157.2 mg/dl, uric acid 11.8 mg/dl and lactic dehydrogenase 478 IU/1. There was no laboratory data suggestive of disseminated intravascular coagulation. On the day of admission, percutaneous right nephrostomy was performed. Prompt diuresis could be obtained but bleeding through the nephrostomy occurred and required 400 ml of blood