病例報告-便秘造成腎水腫
黃煒軒、鄒頡龍、張兆祥
中國醫藥大學附設醫院 泌尿部
Case report-constipation cause hydronephrosis
Wei-Hsuan Huang, Chieh-Lung Chou, Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Background:
Hydronephrosis, literally mean water inside the kidney. In image finding, we could found fluid accumulation in renal pelvis and calyces and cause dilatation. Hydronephrosis was cause by obstruction of urinary tract. Structural abnormalities of the junctions between the kidney, ureter, and bladder that lead to hydronephrosis can occur during fetal development. Untreated, it would lead to atrophy of kidney and cause renal failure. Hydronephrosis could be cause by many reasons such as stones, tumors, ureter stricture, ureter kinking, V-U reflex, tumor outer compression, etc.. But it was rarely cause by constipation. This time, we would present a case with hydronephrosis which was cause by constipation
Case report:
A 77-year-old housewife with history of hypertension under medication control for several years and ICH s/p op with aphasia/ right hemiplegia came to our hospital due to general malaise.Cre found 3.12 and GFR found only 14. Abdominal CT revealed bilateral hydroureter and hydronephrosis. Large amount of stool impaction in colon was also found. Hydroureter and hydronephrosis was still persisted even with Foley catheter indwelling. Under the diagnosis of 1.newly diagnosed DM with hyperosmolar hyperglycemic state 2.UTI 3. AKI 4.bilateral hydroureter and hydronephrosis, she was admitted for further survey and care. After admission, Urologist was consulted for Hydronephrosis survey and renal sono was arranged after 1 week and hydronephrosis was still persisted. We had suggested for constipation management. After 1 week constipation management, we arrange renal echo for follow up and found hydronephrosis had improved. Renal function was back to normal range(Cre: 0.36/GRF 174) Under the condition was stable, she could be discharge and OPD follow up.
Discussion
Hydronephrosis was usually cause by calculi. Sometimes it was cause by tumor obstruction such as UCC. Other causes by Ureteropelvic junction obstruction, Vesicoureteral reflux were also reported. But hydronephrosis cause by severe constipation was rarely reported. Our purpose was to bring up the awareness of this problem with clearly image and raise the opinion that severe constipation may cause hydronephrosis and acute renal failure.
Conclusion:
Constipation was usually happened in elderly patient. Patient with hydronephrosis should be keep in mild that constipation may be the reason and Digital examination should be performed. This case was added to the database and hopefully to raise the awareness of this disorder.