Abstract
Post-obstructive diuresis (POD) following decompression of urinary tract obstruction is usually a self-limiting phenomenon. However, prolonged bilateral ureteral obstruction (BUO) can cause severe structural and functional tubular damage. We present a case of POD resulting from partial nephrogenic diabetes insipidus and discuss the diagnosis, treatment, and prognosis.
Highlights
We present a case of Post-obstructive diuresis (POD) resulting from partial nephrogenic diabetes insipidus and discuss the diagnosis, treatment, and prognosis
Post-obstructive diuresis (POD), defined as urine output of 200 mL/hr for two consecutive hours or >3L/24hours, is a polyuric response initiated by the kidneys after the relief of a ureteral obstruction to eliminate accumulated solute and volume
He had a history of intermittent nocturnal enuresis for the past two years. He was occasionally taking tadalafil, a phosphodiesterase type 5 (PDE-5) inhibitor, and had noticed that his urinary symptoms abated during that period. His baseline renal function was suggestive of chronic kidney disease (CKD) stage 3 in prior assessments wherein a serum creatinine of 1.3 mg/dL with estimated glomerular filtration rate 58 was noted
Summary
Post-obstructive diuresis (POD), defined as urine output of 200 mL/hr for two consecutive hours or >3L/24hours, is a polyuric response initiated by the kidneys after the relief of a ureteral obstruction to eliminate accumulated solute and volume. He was occasionally taking tadalafil, a phosphodiesterase type 5 (PDE-5) inhibitor, and had noticed that his urinary symptoms abated during that period His baseline renal function was suggestive of chronic kidney disease (CKD) stage 3 in prior assessments wherein a serum creatinine of 1.3 mg/dL with estimated glomerular filtration rate (eGFR) 58 was noted. Urodynamic studies were notable for decreased detrusor contractility possibly related to the chronicity of his obstruction, necessitating the maintenance of a chronic indwelling urinary catheter prior to successful transurethral photovaporization of the prostate on day 98. He underwent a voiding trial on postoperative day 3, successfully emptied his bladder, and has been doing clinically well since
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