Calculus Related Acute Renal Failure; Management Strategies

Abstract

Background. Urolothises is one of the most common and oldest disease of urinary tract. It is endemic in
Pakistan and the incidence of calculus renal failure is high. This is due to poor initial manage-ment.
Methods. It is an observational study conducted at the Department of Urology, Services Hospital, Lahore
from April 2001 to March 2003. In this study we evaluated the patients with calculus renal failure regarding
their preoperative, operative, postoperative management and improvement in renal function after the
removal of stones. Twenty patients, 13 male and 7 female were included in this study. The chief presenting
symptom was anuria in 20 (100%) of patients. Ultrasonography, X-ray KUB and Ante-grade pyelography
were the main investigations regarding the site, size of stone, degree of hydronephrosis and echogenicity
of the kidneys. Percuta-neous Nephrostomy alone, Acute Peritoneal Dialysis alone and Percutaneous
Nephrostomy with Acute Peritoneal Dialysis were the emergency procedures performed to save the life of
the patients and to plan for a definite surgical procedure. After the stabilization of the renal function, definite
surgical procedure in the form of pyelo-lithotomy and ureterolithotomy were performed.
Results. Results were analyzed by considering the duration of anuria, degree of obstruction
(hydronephrosis) and duration of max-imum improvement. Overall thirteen (65%) patients had good result,
five (25%) patients had satisfactory results and two (10%) patients had poor results. Anuria due to stones in
the urinary tract is a urological emergency.
Conclusion. Prompt and early interventions can save the patient from developing irreversible renal
damage