A surprising case of bilateral ureteric stones causing acute renal failure and anuria

Introduction: We present a case of bilateral ureteric colic that causes anuric acute renal failure. Bilateral ureteric colic causing acute renal failure is not a new presentation. However, the patient had only 3 mm calculi, making our case unique. Background: Bilateral renal calculi are an uncommon cause of acute kidney injury (AKI). Obstructing ureteroliths rarely lead to AKI without any underlying renal disease or anatomic abnormalities, such as a solitary kidney or horseshoe kidney. The literature has reported the incidence of a unilateral ureterovesicular junction obstruction secondary to a stone as 20%. However, there are a very few case reports in the literature of urology, nephrology or emergency medicine regarding the incidence of bilateral ureteric calculi. Cases of bilateral ureteric calculi are rare, and cases with AKI and anuria are very rare. Case presentation: A 30-year-old male presented with bilateral colicky flank pain for 4 days and started to develop macroscopic haematuria. After proper pain management in the Emergency Department, the patient was found to have a raised serum creatinine level (152 μmol/L). A CT scan was performed showing two 3 mm calculi in the left and right proximal ureters. Ultrasound showed moderate left and mild right hydroureteronephrosis. Due to the relatively small size of the stones, and the clinical image of the patient, he was planned for medical expulsive therapy. Surprisingly, the patient developed complete anuria for 2 days and presented to the ED with a serum creatinine level of 843 μmol/L. Bilateral double J stents were placed and urgent ureteroscopy was done. Following treatment, the patient's condition significantly improved and his renal function returned to normal within 4 days. Conclusion: Even small bilateral stones can result in acute kidney injury.