An unusual cause of acute renal failureBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4574 (Published 19 November 2009) Cite this as: BMJ 2009;339:b4574
- Philip Dilks, specialty registrar, clinical radiology1,
- Andrew Shawyer, specialty registrar, clinical radiology1,
- Thomas C Booth, specialist registrar, clinical radiology2
- 1Barts and the London NHS Trust, London EC1A 7BE
- 2Royal Free Hospital NHS Trust, London NW3 2XA
- Correspondence to: P Dilks
A 46 year old woman with an uneventful medical history presented to her general practitioner with pain in her right loin and tiredness. Examination was unremarkable. Routine blood tests were within normal limits except for a urea of 20 mmol/l and creatinine of 604 μmol/l. A renal ultrasound showed bilateral pelvi-calyceal dilation. She underwent abdominal radiography and computed tomography (figs 1⇓ and 2⇓).
1 What interventions have been carried out and what can be deduced about the position of the ureters on the abdominal radiograph?
2 What does the computed tomogram show?
3 What is the aetiology of this condition and what other diagnostic options are available?
4 How should it be managed?
1 The plain radiograph shows a right sided percutaneous nephrostomy catheter, bilateral ureteric (thermoexpandable) stents, and medial displacement of the ureters (fig 3⇓).
2 The axial contrast enhanced computed tomogram shows a rim of soft tissue encasing the aorta that has medially displaced the ureters. This is in keeping with a diagnosis of retroperitoneal fibrosis.
3 Causes can be categorised as idiopathic or secondary to a wide range of conditions including neoplastic disease, infection, inflammation, trauma, and drug reactions. Ultrasound, intravenous urography, magnetic resonance imaging, and nuclear medicine can also help diagnose the condition and monitor response to treatment.
4 Treatment includes modification of risk factors and withdrawal of the causative agent, surgical and interventional relief of the mechanical …