Chapter 53 · Urological emergencies in special populations
Patients with a solitary kidney
Special considerations
- A solitary functioning kidney is a high-risk state because any injury can lead to end-stage kidney failure.
- Obstruction of a solitary kidney is an emergency.
Common emergencies
- Obstruction (stone, stricture, tumor): urgent drainage.
- Infection (pyelonephritis, sepsis).
- Trauma—even minor injury is dangerous.
- AKI (prerenal, intrinsic renal, postrenal).
Diagnosis
- Ultrasonography for hydronephrosis.
- CT if needed.
- Creatinine, hourly urine output.
Emergency management
- Obstruction: urgent drainage (stent or nephrostomy).
- In infection: antibiotics + drainage if obstruction is present.
- Trauma: maximize renal preservation; embolization rather than nephrectomy.
- AKI: restore drainage and correct hyperkalemia and acidosis.
Algorithm
| Step | Action |
|---|---|
| 1 | Assess urine output and creatinine |
| 2 | Ultrasonography (hydronephrosis) |
| 3 | Obstruction → urgent drainage |
| 4 | Infection → antibiotics + drainage |
| 5 | Trauma → organ-preserving management |
Renal transplants and urinary diversions
- In a transplant recipient with reduced urine output, pain, fever, or rising creatinine, contact the transplant center early and assess for obstruction, vascular complications, infection, urine leakage, and rejection.
- Initial imaging: Doppler ultrasonography of the graft; further CT, MRI, or interventional investigations depend on the clinical question and kidney function.
- In a patient with a urostomy or another urinary diversion, establish the type of surgery, usual output characteristics, stoma and catheter patency, electrolytes, and signs of infection. Do not perform blind instrumentation without knowing the anatomy.
- If obstruction or an infected device is present, urgently restore drainage and coordinate device replacement with the relevant service.