Dr B.Aravind Reddy 2nd yearNephrology Resident Gandhi Hospital Case Snippet Dr B.Aravind Reddy 2nd yearNephrology Resident Gandhi Hospital

Case Report… 45 Yr old Male Mr.X ,non DM, nonHTN C/o Loin pain, dysuria for 15 days. Oligoanuria for 3 days Azotemia for 3 days. H/s/o LUTS H/o Gravelluria. H/o Urology surgery – 10 years back at karimnagar(details not available),lost follow up there after. At admission : general and systemic examination : unremarkable

Investigations… Hb-10.3gm/L TLC-16800 PLT-2.3L LFT-WNL S.Creat 18mg/dl CUE Alb-nil RBC-nil Pus cells plenty Urine C/S sterile USG abdomen: Right kidney normal.Left gross HDUN, hyperechoic content noted in the bladder with posterior shadow extending upto ureteral opening : suggestive of calcified DJ stent

Imaging…X ray KUB Migration Encrustation Fragmentation Stone formation

CT plain KUB: 30mm calculus in urinary bladder with calcified DJ stent traceable upto distal ureter.

Diagnosis and management Forgotten DJ stent with complications Left gross hydroureteronephrosis with Vesical calculus with urosepsis – AKI(AKIN3)recovered. Initiated on HD through Right IJV . Left PCN done Ursl +Left DJS removal followed by Open cystolithotomy. Serum creatinine was 2mg/dl and is dialysis independent.

Ideal ureteral stent… Easily inserted from any access Resistant to migration Optimal flow characteristics Well tolerated by patient Biocompatible Biodurable Resistant to encrustation Nonrefluxing Radiopaque or visible at US Easily exchanged and removed Affordable

Review of Literature…

Take home message… Adequate counseling before putting DJ stent. Stringent and regular follow up of those with stent.

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