A 50 year old female is admitted with abdominal pain and anuria. Radiological studies reveal bilateral impacted ureteric stones with hydronephrosis. Urine analysis showed RBCs with pus cells in urine. Serum creatinine level was 16mg/dL and blood urea level was 200 mmol/L; which of the following should be the immediate treatment.
## Core Concept
The patient presents with symptoms and laboratory findings indicative of acute kidney injury (AKI) likely caused by bilateral ureteric obstruction due to impacted stones, complicated by urinary tract infection (UTI) as suggested by the presence of RBCs, pus cells, and significant elevation of serum creatinine and blood urea levels. The clinical scenario requires immediate intervention to relieve the obstruction and manage the infection.
## Why the Correct Answer is Right
The correct answer involves **urgent stenting or nephrostomy** to relieve the obstruction. This procedure is crucial for several reasons:
- It helps to immediately relieve the obstruction, allowing urine to drain and thereby reducing the pressure within the kidneys.
- It can help in reducing the serum creatinine and urea levels by improving renal function.
- It is essential in managing the infection by allowing for proper drainage of infected urine.
## Why Each Wrong Option is Incorrect
- **Option A:** This option might suggest conservative management, which is inappropriate in this scenario given the severity of symptoms, significant renal impairment, and the presence of infection. Conservative management alone would not address the obstruction or the infection adequately.
- **Option B:** This could imply antibiotic therapy alone, which, although important for treating the UTI, does not address the mechanical obstruction causing the AKI. Antibiotics can help manage the infection but will not be effective in relieving the obstruction.
- **Option C:** This might imply a less immediate or less invasive approach that does not directly address the need for urgent relief of obstruction and management of infection.
## Clinical Pearl / High-Yield Fact
A key point to remember is that in cases of bilateral ureteric obstruction or in scenarios where there is a single functioning kidney with obstruction, **prompt intervention** (such as stenting or nephrostomy) is critical to prevent long-term renal damage or even loss of renal function. The presence of infection (pyelonephritis) complicates the scenario, necessitating not only drainage but also appropriate antibiotic therapy.
## Correct Answer Line
**Correct Answer: D. Urgent stenting or nephrostomy.**