Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2017  |  Volume : 28  |  Issue : 1  |  Page : 199--200

End-stage renal disease secondary to pelvic organ prolapse


Shinji Machida, Naohiko Imai, Daisuke Oishi, Katsuomi Matsui, Sayuri Shirai, Yugo Shibagaki 
 Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Miyamae-Ku, Kawasaki, Kanagawa, Japan

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




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 2020 Feb 17 ];28:199-200
Available from: http://www.sjkdt.org/text.asp?2017/28/1/199/198280


Full Text

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}{Figure 2}{Figure 3}

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

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2Hussein 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.
3Beverly 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.
4Hadar H, Meiraz D. Total uterine prolapse causing hydroureteronephrosis. Surg Gynecol Obstet 1980;150:711-4.