A rare case of bilateral obstructive uropathy with severe azotemia (Creatinine 19.14 mg/dL) managed via unilateral DJ stenting: A urological emergency

Abstract

Background: Obstructive uropathy resulting in acute kidney injury (AKI) is a urological emergency with high morbidity and mortality if not managed promptly. In elderly patients, delayed intervention can result in irreversible renal damage. This case report highlights the surgical management of a rare bilateral ureteric obstruction in an elderly female with a critically elevated serum creatinine of 19.14 mg/dL. Case Presentation: An 80-year-old female presented with anuria and altered mental status. Laboratory tests revealed severe azotemia (Creatinine: 19.14 mg/dL, Urea: 137.4 mg/dL). Imaging confirmed bilateral hydroureteronephrosis with multiple ureteric calculi. The right kidney was shrunken and non-functional, while the left was salvageable. After emergency hemodialysis and stabilization, endoscopic evaluation showed an obstructing left-sided calculus and a non-drainable right ureter. A DJ stent was placed on the left side only. Outcome: Renal function improved significantly postoperatively (Creatinine reduced to 2.80 mg/dL). Uremic symptoms resolved, and the patient was discharged on Day 7 with follow-up advice. Conclusion: Bilateral obstructive uropathy causing AKI is reversible if diagnosed and managed early. Endourological intervention remains the cornerstone in elderly patients, particularly when nephroprotection and minimal invasiveness are essential.