Acute reversible kidney injury secondary to bilateral ureteric obstruction

Background: Acute reversible kidney injury (ARKI) secondary tobilateral ureteric obstruction (BUO) is a common urological problem.Our goals were to describe the etiology, management andoutcomes of such patients identified between 2006 and 2009 andto compare them with a similar historical study published in 1982.Methods: Chart review was performed on 49 patients with AKRIsecondary to BUO. ARKI was defined as ≥33% decrease in serumcreatinine after intervention. Those with malignant and benigncauses of obstruction were identified and management and outcomedata were collected.Results: Of these 49 patients, 83% had BUO secondary to malignancy,28% of these presenting for the first time. Prevalence ofbladder cancer was increased (p = 0.04) and cervix trended lower(p = 0.07) compared with the earlier study; prostate cancer wasunchanged (p = 0.51). The average survival was 239 days; 90%of patients died within a year after presenting with BUO from amalignant etiology. Compared with the 1982 group, there weretrends towards a decrease in the frequency of retroperitoneal fibrosis(p = 0.08) and an increase in bilateral ureteric calculi (p = 0.16)in the benign group.Conclusions: Patients with ARKI secondary to BUO most likelyhave an underlying malignancy, with almost a third of them beingdiagnosed for the first time. Prevalence of bladder cancer increasedwhile cervical cancer trended lower. The cause for the former isunclear; the latter may be due to aggressive screening. Prostate cancerremained unchanged despite the widespread implementation ofprostate-specific antigen testing. Patients with an underlying malignancydo poorly and those with a newly diagnosed malignancydo worst. Those with ARKI secondary to benign causes did well.