Post-traumatic intravesical clot retention causing recurrent post-renal acute kidney injury in a pregnant woman: A case report

Abstract

Intravesical blood clot obstruction is a recognized cause of postrenal acute kidney injury (AKI), but recurrent obstruction after apparent renal recovery may be difficult to recognize. We report a 30-year-old pregnant woman at approximately 27 weeks’ gestation who developed severe AKI after a motor vehicle accident with gross hematuria. At the first admission, serum creatinine was 8.210 mg/dL, and ultrasonography showed bilateral pelvicalyceal ectasia without a definite obstructing lesion. After bladder drainage, renal function rapidly improved, with serum creatinine decreasing to 1.130 mg/dL without hemodialysis. Ten days later, the patient was readmitted with recurrent gross hematuria, anuria, hyperkalemia, metabolic acidosis, and recurrent AKI. Repeat ultrasonography demonstrated a large intravesical blood clot, supporting clot-related obstruction as the most likely mechanism. Repeat bladder drainage and one emergency hemodialysis session were followed by marked renal recovery. The subsequent course was complicated by fetal loss, postpartum hemorrhage, puerperal sepsis, multiorgan dysfunction, and death.

The clinical importance of this case lies in the recurrence of severe postrenal AKI after near-complete renal recovery. In patients with trauma-associated gross hematuria, rapid improvement after bladder drainage does not exclude persistent or recurrent clot-related obstruction. Repeat urinary tract imaging should be considered when hematuria, anuria, or kidney dysfunction recurs, particularly when initial imaging shows upper urinary tract dilatation without a clear cause.