Hydronephrosis

Patient Presentation:
K.P, a 57 year old male presented to ER with complains of 10/10 right flank pain, nausea, fever, chills, and decreased appetite x 3 days. Pt is diaphoretic and writhing in pain. Pt reports the pain is sharp and intermittent. K.P. also reports hematuria and no prior urological problem.

PMH: HTN, DM-II
BMP: Na+ 144, Cl- 97, K+ 4.0, BUN 52, creatinine 2.4, Glucose: 187, HCO3- 18, Phosphate 4.5, Mg++ 2.0, Ca++ 10
WBC: 21,000, Hgb: 14, Hct: 46, PLT: 200,000
UA: shows elevated WBC and RBC’s and bactiuria (>100,000)
CT scan (non-contrast) of abdomen/pelvis shows large right ureteral kidney stone and right hydronephrosis
Vitals: T 38.5 °C, BP 101/52, HR 113 Sinus tachycardia, RR 28, O2 sat: 98% Room air

Diagnosis:
Hydronephrosis caused by kidney stone complicated by UTI/Sepsis.

Treatment:
Pt pan cultured, given Tylenol® for fever and started on broad spectrum antibiotics for urinary tract infection. Pt given 3L NS bolus and started on maintenance fluid of NS at 125ml/hr. PRN Dilaudid® was given for pain management. K.P. was then sent to Medical step-down unit for further management. Decreased blood tinged urinary output from Foley was noted. Pt was eventually sent IR for right percutaneous nephrostomy tube placement.

After nephrostomy tube placement, pt continued on IV fluids and pain management regimen. Nephrostomy tube was drained to gravity and site kept clean with dressing intact. Initially, there was a large amount of output from nephrostomy. Eventually pt was sent for extracorporeal shock wave lithotripsy. Hydronephrosis resolved and full function of kidneys was recovered. Nephrostomy tube was then discontinued. Urinary tract infection eventually resolved and pt was discharged home.