Unilateral Ureterolithiasis Accompined By the Risk of Acute Kidney Injury: Case Report

Abstract

Background: Urolithiasis is the condition of stone formation in the urinary tract, which remains a significant health issue worldwide. The incidence of cases is higher in men than women. Flank pain is the most common manifestation in patients with urolithiasis. The management of urolithiasis includes conservative treatment, lifestyle modifications, medication therapy, medical intervention, and surgical procedures. Complications of urolithiasis may include urinary tract infection and urinary tract obstruction, both of which have the potential to cause acute kidney injury.

Case Report: A 36-year-old male presented with severe left flank pain (visual analogue scale 8) that had worsened since two days prior to hospital admission. The pain was continuous, non-radiating, and worsening. The complaint was accompanied by a burning sensation during urination, incomplete urination, and difficulty in passing urine. The patient also reported reddish and cloudy urine.

Physical examination revealed tenderness in the left lumbar region and pain upon percussion of the left costovertebral angle (CVA). Hematologic tests showed leukocytosis, neutrophilia, elevated serum creatinine, and a decreased estimated glomerular filtration rate (eGFR). Routine urinalysis revealed increased white blood cells, red blood cells, and protein. A Urology Computed Tomography (CT) scan showed left ureterolithiasis at the L4 level, measuring 2.28 cm, along with hydroureter and grade IV hydronephrosis. An open left ureterolithotomy was performed based on medical indications and due to the limitations of urological facilities at our hospital.

Conclusion: Flank pain is the most common manifestation in patients with urolithiasis. Early diagnosis of complications can improve the patient's prognosis. The management of urolithiasis depends on medical indications and can be adjusted according to available facilities.