A 55-year-old man presented to the emergency clinic due to difficult urination and confusion. A suprapubic mass was palpated during examination. Urea (452 mg/dL) and creatinine (21.3 mg/dL) levels were elevated. Non-contrast enhanced computed tomography (CT) scan revealed bilateral hydronephrosis and dilated ureters. Within a few hours after a Foley catheter insertion, 4,500 mL of urine was drained. At the 24th hour of admission, the postrenal acute kidney injury improved rapidly with serum creatinine and urea levels declining to 1 mg/dL and 58 mg/dL, respectively. On CT-urography, free passage of contrast media from the pelvis renalis to around the left kidney was detected. It is interpreted as rupture of the renal pelvis ( and B).
Spontaneous rupture of the renal pelvis is a rare condition, usually caused by ureteral calculi, ureteral instrumentation, tumors, and trauma (1-3). In this patient, the cause was assumed to be a bladder globe, thus, a double J-stent was inserted into the left ureter. The urodynamic examination revealed a hyposensitive and hypocompliant bladder with normal capacity. Prostate volume was 38 mL. The patient performed intermittent urinary self-catheterization and has a stable serum creatinine value.
Footnotes
Informed Consent: Obtained.
Peer-review: Externally peer reviewed.
Authorship Contributions
Concept: M.G., R.S., Design: M.G., Data Collection or Processing: A.S.A, M.G., Analysis or Interpretation: A.S.A., R.S., Literature Search: A.S.A., R.S., Writing: A.S.A., R.S.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.
References
Zhang H, Zhuang G, Sun D, Deng T, Zhang J. Spontaneous rupture of the renal pelvis caused by upper urinary tract obstruction: A case report and review of the literature. Medicine (Baltimore) 2017;96:9190.
Janardanan S, Kulkarni R, Arumainayagam N. Simultaneous Rupture of the Bladder and Pelvicaliceal System Because of Blunt Abdominal Trauma: A Rare Case. J Endourol Case Rep 2019;5:42-4.
Gulati A, Prakash M, Bhatia A, Mavuduru R, Khandelwal N. Spontaneous rupture of renal pelvis. Am J Emerg Med 2013;31:762.
