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Anuria in a 9-month-old infant resulting from ureteral cystine stones.

Aboutaleb H - Korean J Urol (2011)

Bottom Line: Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction.A left ureterolithotomy was the final management.Stone analysis revealed pure cystine crystals.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Minoufiya University Hospitals, Minoufiya, Egypt.

ABSTRACT
Pediatric urolithiasis and calcular anuria in early infancy are rare. Cystine stones may develop in utero or during early infancy. We report the case of a female 9-month-old infant with obstructive anuria resulting from cystine stones in a single functioning unit. She presented to the emergency department owing to the absence of micturition for 3 days. Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction. Her laboratory values were as follows: serum creatinine 6.7 mg/dl, Na 132 mEq/l, K 6 mg/dl, and hematocrit 32%. An urgent percutaneous nephrostomy tube was inserted into the left side for urinary drainage, and her serum levels of creatinine and K returned to normal within 3 days. A left ureterolithotomy was the final management. Stone analysis revealed pure cystine crystals.

No MeSH data available.


Related in: MedlinePlus

Preoperative plain abdominal X-ray kidney, ureter, and bladder showing multiple bilateral calculi (arrows).
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Figure 2: Preoperative plain abdominal X-ray kidney, ureter, and bladder showing multiple bilateral calculi (arrows).

Mentions: We report the case of a female 9-month-old infant who was presented to the emergency department because of the absence of micturition for 3 days. The pregnancy and delivery history was normal. Clinical examination showed no congenital abnormalities. The infant's body weight was 7.5 kg. Neither the bladder nor the kidneys were palpable clinically. The infant was quiet in bed. A Foley urethral catheter was inserted and revealed no urine in the bladder. Serum creatinine was 6.7 mg/dl, serum K was elevated to 6 mEq/dl, Na was 132 mEq/dl, and hematocrit was 32%. Abdominal ultrasound showed mild hydronephrosis of the left kidney (Fig. 1A). The right kidney was atrophic with poor corticomedullary differentiation and stones (Fig. 1B). Kidney, ureter, and bladder showed four radiopaque shadows opposite the left sacroiliac joint and one in the renal area on the right side. Moreover, another radiopaque shadow was found at the level of L3 on the right side (Fig. 2). A percutaneous nephrostomy tube was inserted into the dilated left pelvicaliceal system for drainage for several days. After the intervention, the serum creatinine level improved to 1.6 mg/dl and K returned to a normal level on the third day. Exploration of the left middle third of the ureter was performed with the removal of four stones and a double (DJ) stent was fixed. Creatinine returned to 0.5 mg/dl after 2 weeks. The stent was removed after 2 weeks. Chemical analysis of the stones revealed pure cystine crystals. Right kidney function will be evaluated by [DMSA] isotopes. A right nephrectomy may be considered because of the stones and infection. Metabolic workup for cystinuria was performed via a positive nitroprusside test. The diagnosis was confirmed by stone analysis by use of chemical methods. Three months later, the results of a renal ultrasound and renal function tests with urine analysis were repeated and were shown to be normal.


Anuria in a 9-month-old infant resulting from ureteral cystine stones.

Aboutaleb H - Korean J Urol (2011)

Preoperative plain abdominal X-ray kidney, ureter, and bladder showing multiple bilateral calculi (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3198241&req=5

Figure 2: Preoperative plain abdominal X-ray kidney, ureter, and bladder showing multiple bilateral calculi (arrows).
Mentions: We report the case of a female 9-month-old infant who was presented to the emergency department because of the absence of micturition for 3 days. The pregnancy and delivery history was normal. Clinical examination showed no congenital abnormalities. The infant's body weight was 7.5 kg. Neither the bladder nor the kidneys were palpable clinically. The infant was quiet in bed. A Foley urethral catheter was inserted and revealed no urine in the bladder. Serum creatinine was 6.7 mg/dl, serum K was elevated to 6 mEq/dl, Na was 132 mEq/dl, and hematocrit was 32%. Abdominal ultrasound showed mild hydronephrosis of the left kidney (Fig. 1A). The right kidney was atrophic with poor corticomedullary differentiation and stones (Fig. 1B). Kidney, ureter, and bladder showed four radiopaque shadows opposite the left sacroiliac joint and one in the renal area on the right side. Moreover, another radiopaque shadow was found at the level of L3 on the right side (Fig. 2). A percutaneous nephrostomy tube was inserted into the dilated left pelvicaliceal system for drainage for several days. After the intervention, the serum creatinine level improved to 1.6 mg/dl and K returned to a normal level on the third day. Exploration of the left middle third of the ureter was performed with the removal of four stones and a double (DJ) stent was fixed. Creatinine returned to 0.5 mg/dl after 2 weeks. The stent was removed after 2 weeks. Chemical analysis of the stones revealed pure cystine crystals. Right kidney function will be evaluated by [DMSA] isotopes. A right nephrectomy may be considered because of the stones and infection. Metabolic workup for cystinuria was performed via a positive nitroprusside test. The diagnosis was confirmed by stone analysis by use of chemical methods. Three months later, the results of a renal ultrasound and renal function tests with urine analysis were repeated and were shown to be normal.

Bottom Line: Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction.A left ureterolithotomy was the final management.Stone analysis revealed pure cystine crystals.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Minoufiya University Hospitals, Minoufiya, Egypt.

ABSTRACT
Pediatric urolithiasis and calcular anuria in early infancy are rare. Cystine stones may develop in utero or during early infancy. We report the case of a female 9-month-old infant with obstructive anuria resulting from cystine stones in a single functioning unit. She presented to the emergency department owing to the absence of micturition for 3 days. Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction. Her laboratory values were as follows: serum creatinine 6.7 mg/dl, Na 132 mEq/l, K 6 mg/dl, and hematocrit 32%. An urgent percutaneous nephrostomy tube was inserted into the left side for urinary drainage, and her serum levels of creatinine and K returned to normal within 3 days. A left ureterolithotomy was the final management. Stone analysis revealed pure cystine crystals.

No MeSH data available.


Related in: MedlinePlus