Question:
A 50 year old female is admitted with abdominal pain and anuria. Radiological studies revealed bilateral impacted ureteric stones with hydronephrosis. Urine analysis showed RBCs with pus cells in urine. Serum creatinine level was 16 mg/dl and urea level was 200 mmol/l. Which of the following should be the immediate treatment?
A 50 year old female is admitted with abdominal pain and anuria. Radiological studies revealed bilateral impacted ureteric stones with hydronephrosis. Urine analysis showed RBCs with pus cells in urine. Serum creatinine level was 16 mg/dl and urea level was 200 mmol/l. Which of the following should be the immediate treatment?
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In obstructed plus infected kidneys, drain first and remove the stone later.
Updated On: Jun 24, 2026
- Hemodialysis
- 'J' stent drainage
- Lithotripsy
- Ureteroscopic removal of stones
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The Correct Option is B
Solution and Explanation
Step 1: Frame the emergency. The patient has bilateral impacted ureteric stones causing complete obstruction. Anuria with a serum creatinine of \(16\) mg/dl indicates obstructive (post-renal) acute kidney injury. The pus cells suggest associated infection sitting behind an obstructed system, which is a urological emergency.
Step 2: Decide the priority. In obstructive AKI the kidney cannot recover until the obstruction is relieved and the urine drains. Therefore the immediate goal is urgent decompression of the collecting system, not definitive stone removal.
Step 3: Choose the drainage method. A double 'J' stent (or alternatively percutaneous nephrostomy) bypasses the impacted stone, restores urine flow, drains infected urine, and lets the obstructed kidneys recover. It is quick and can be done even in a sick, septic patient.
Step 4: Reject the distractors. Lithotripsy (ESWL) and ureteroscopic stone removal are definitive treatments that should not be done in the acute setting on an obstructed, infected, uraemic patient, because manipulating an infected obstructed system risks pushing infection into the circulation. Hemodialysis corrects the biochemistry but does nothing for the mechanical obstruction; it is added only if life-threatening uraemia, hyperkalaemia or fluid overload persists, and even then drainage is still needed.
Answer: 'J' stent drainage (Option B).
Step 2: Decide the priority. In obstructive AKI the kidney cannot recover until the obstruction is relieved and the urine drains. Therefore the immediate goal is urgent decompression of the collecting system, not definitive stone removal.
Step 3: Choose the drainage method. A double 'J' stent (or alternatively percutaneous nephrostomy) bypasses the impacted stone, restores urine flow, drains infected urine, and lets the obstructed kidneys recover. It is quick and can be done even in a sick, septic patient.
Step 4: Reject the distractors. Lithotripsy (ESWL) and ureteroscopic stone removal are definitive treatments that should not be done in the acute setting on an obstructed, infected, uraemic patient, because manipulating an infected obstructed system risks pushing infection into the circulation. Hemodialysis corrects the biochemistry but does nothing for the mechanical obstruction; it is added only if life-threatening uraemia, hyperkalaemia or fluid overload persists, and even then drainage is still needed.
Answer: 'J' stent drainage (Option B).
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