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Community Minded

Anuric AKI
A 51-year-old female presents with back pain is found to have a lumbar mass on MRI and undergoes spine surgery. Four days after a CT with contrast, and two days after an otherwise unremarkable postoperative course, she develops AKI with a creatinine of 2.5 mg/dl. She becomes anuric. Imaging shows mild hydronephrosis at best, but she is found to have retroperitoneal lymphadenopathy. Is this “post-op ATN,” delayed contrast associated AKI, or could this be a non-dilated obstruction? Is anuria a helpful clue? Your urologist refuses to intervene without obvious hydronephrosis. This case is very illustrative of the tried and true tenet, “never miss obstruction,” in AKI. How would you have handled this case?

Summary provided by Roger Rodby, MD, FASN.
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