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G390(P) An unusual complication of a common condition
  1. AP Maxted,
  2. MT Christian
  1. Nottingham Children’s Renal and Urology Unit, Nottingham Children’s Hospital, Nottingham, UK

Abstract

Post-renal obstruction is an unusual cause of acute kidney injury (AKI) in the paediatric population, with haemolytic-uraemic syndrome being the commonest cause of acquired AKI.1–3 We present a case of a two year old with AKI secondary to severe chronic constipation.

The patient presented with abdominal pain and bloating on the background of chronic constipation and Fragile X syndrome. Initial treatment was for constipation. However, after clinical deterioration and concerns on clinical examination an abdominal film was obtained (Figure 1).

Abstract G390(P) Figure 1

Abdominal x-ray

This shows a large mass in the right iliac fossa, possibly arising from the pelvis, leading to suspicion of a malignant diagnosis. Biochemistry results showed acute kidney injury with a creatinine of 166 µmol/L. Further investigations showed a raised CRP. Urine and blood cultures grew Enterococcus faecalis. The patient was started on intravenous antibiotics and fluid restricted.

The next day he was transferred to a tertiary renal unit where ultrasound investigation showed the mass to be a large bladder, combined with bilateral hydronephrosis. A likely diagnosis of constipation causing post-renal obstruction was made and after catheterisation and faecal disimpaction the patient improved, (Figure 2).

Abstract G390(P) Figure 2

Creatinine over time

A repeat ultrasound showed improvement in the hydronephrosis and subsequent MRI scanning demonstrated a normal spine and a large bladder with no mass/lesion causing bladder outflow obstruction.

Constipation is a rare, but previously documented cause of acute renal injury.4 This case further demonstrates the need to have an open mind to rarer consequences of common conditions and indeed, diligence in investigating these as a possibility.

References

  1. Williams DM. Acute kidney failure, A Paediatric Experience Over 20 years. Arch Pediatr Adolesc Med. 2002; 156:893–900

  2. Moghal NE. A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol. 1998; 49(2):91–5

  3. Shaheen IS. Acute renal failure in children: Eitology, Treatment and Outcome. Saudi J Kidney Dis Transplant 2006; 17(2):153–158

  4. Barrett MJ and Macken S. Chronic constipation causing obstructive nephropathy in a delayed toddler. BMJ Case Rep. 2012 Jun 14;2012. pii: bcr0220125902. doi: 10.1136/bcr.02.2012.5902

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