MO294: Multidisciplinary Management of Obstructive Anuria: Uro-Nephrological Interdependence of the Patient Service

Abstract

Abstract BACKGROUND AND AIMS Obstructive anuria is defined as a total cessation of diuresis or a volume of <200 or even 400 mL/24 h due to bilateral or unilateral blockage of a single anatomical or functional kidney. It is rapidly the cause of acute renal failure, endangering the vital prognosis in the short term and requiring emergency treatment in a specialised environment, whatever its aetiology. It accounts for 10% of all anurias. They are significant conditions that might jeopardise the kidney's functional prognosis. The goal of our study is to to describe the epidemiological profile, clinical and medical-surgical management performed at the CHU IBN ROCHD CASABLANCA in partnership with various services to manage this pathology, which remains severe. METHOD From January 2018 to December 2020, we conducted a 3-year retrospective and descriptive study of patients treated at the CHU IBN ROCHD of Casablanca's nephrology and haemodialysis department and urology department. RESULTS There were a total of 217 patients; 92 women and 125 men, i.e. 42.39% and 57.6%, respectively, with an average age of 56.7 years ‘22–79’. The circumstances of discovery were: oligo anuria 69.12%, haematuria 23.04% and AEG 7.83%. Obstruction was neoplastic in 64.51%; lithiasis 26.27%; bladder malformation 0.92% and of undetermined aetiology in 4.6%. The neoplastic origin was cervical cancer, followed by bladder and prostate. The mean creatinine level was 86.86mg/L. The indication for haemodialysis was: threatening hyperkalaemia, uraemic syndrome, acidosis and acute lung oedema in 58%, 25.8%, 8.2% and 8% of cases, respectively. The total number of haemodialysis sessions was 260 with an average number of 1.198. Obstacle removal was performed by percutaneous nephrostomy in 70.96% of cases, by double J catheterization in 26.26% of cases. The outcome was good in 78.34% of cases, 13.82% progressed to CKD. Mortality was 6.9%. The risk factors for mortality were: age, aetiology of neoplasia. CONCLUSION Obstructive anuria is an emergency requiring multidisciplinary management. The aetiologies were dominated by pelvic cancers and lithiasis in our context. Depending on the severity of the obstruction, treatment consists of three steps: treatment of metabolic abnormalities induced by acute renal failure, drainage of the obstructed excretory tract and treatment of the source of the obstruction. Prevention is based on early and adequate management of the various causative conditions.