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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 1  |  Page : 199-200
End-stage renal disease secondary to pelvic organ prolapse


Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Miyamae-Ku, Kawasaki, Kanagawa, Japan

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Date of Web Publication12-Jan-2017
 

How to cite this article:
Machida S, Imai N, Oishi D, Matsui K, Shirai S, Shibagaki Y. End-stage renal disease secondary to pelvic organ prolapse. Saudi J Kidney Dis Transpl 2017;28:199-200

How to cite this URL:
Machida S, Imai N, Oishi D, Matsui K, Shirai S, Shibagaki Y. End-stage renal disease secondary to pelvic organ prolapse. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2017 May 26];28:199-200. Available from: http://www.sjkdt.org/text.asp?2017/28/1/199/198280
To the Editor,

A 73-year-old woman with a history of hypertension and dyslipidemia was referred to the clinic for worsening renal function along with general fatigue and loss of appetite. Her serum creatinine was 8.5 mg/dL and blood urea was 121 mg/dL. The estimated glomerular filtration was 4.0 mL/min/1.73 m[2]. Pelvic examination revealed grade 4 cystocele ([Figure 1]). Computed tomography of the abdomen and pelvic showed severe bilateral hydroureteronephrosis ([Figure 2]) and extreme prolapse of the bladder out of the pelvis ([Figure 3]). The patient was referred for gynecologic consultation, and vaginal pessary was inserted. The patient was initiated on emergent hemodialysis for her uremic symptoms.
Figure 1. Pelvic examination revealed grade 4 cystocele.

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Figure 2. Computed tomography of the abdomen and pelvic showed severe bilateral hydroureteronephrosis.

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Figure 3. Computed tomography of the abdomen and pelvic showed extreme prolapse of the bladder.

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Pelvic organ prolapse is the descent of the uterus, bladder or rectum protruding through the vagina.[1] In severe cases, although it is a rare finding, end stage renal disease can occur. The exact mechanism of hydroureteronephrosis has not been clarified completely, and several hypotheses including compression of ureter by uterine blood vessels,[2] kinking of ureter by cardinal ligaments of descended uterus,[3] and entrapment of ureters by genital hiatus against fundus of uterus[4] have been proposed. In any old woman presenting with obstructive renal failure, pelvic organ prolapse should be evaluated with full gynecologic examination.

Conflict of interests: None declared.

 
   References Top

1.
Costantini E, Lazzeri M, Mearini L, Zucchi A, Del Zingaro M, Porena M. Hydronephrosis and pelvic organ prolapse. Urology 2009;73:263-7.  Back to cited text no. 1
    
2.
Hussein NS, Rahman MN, Rifat UN. Bilateral pyonephrosis and end-stage renal disease secondary to pelvic organ prolapse. Saudi J Kidney Dis Transpl 2013;24:810-2.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Beverly CM, Walters MD, Weber AM, Piedmonte MR, Ballard LA. Prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse. Obstet Gynecol 1997;90:37-41.  Back to cited text no. 3
    
4.
Hadar H, Meiraz D. Total uterine prolapse causing hydroureteronephrosis. Surg Gynecol Obstet 1980;150:711-4.  Back to cited text no. 4
    

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Correspondence Address:
Naohiko Imai
Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Miyamae-Ku, Kawasaki, Kanagawa
Japan
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DOI: 10.4103/1319-2442.198280

PMID: 28098131

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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