2020 Volume 33 Issue 2 Pages 175-181
A 12-year-old patient was admitted to our department due to the onset of renal colic symptoms. An ultrasound examination revealed right-sided hydronephrosis which had been caused by the presence of a ureteral stone. In addition, multiple stones in the calyx of both kidneys were observed. Cystinuria was diagnosed based on an increased cystine excretion level. Since renal scintigraphy of the right kidney showed a very low uptake and a renogram showed a severe impairment of the renal function, he was diagnosed with right-sided nephrolithiasis-associated acute kidney injury (AKI). He was advised to maintain a high fluid intake and was treated with potassium citrate in addition to tiopronin. 5 days later, the spontaneous passage of the stone was reported and the renal uptake was found to have recovered according to scintigraphy. However, 5 months later he had a recurrence of a right ureteral stone while showing right-sided AKI similar to the previous episode. The cystine level remained high during outpatient follow-up due to treatment non-adherence. Next, transurethral lithotomy was performed, and no recurrence has since been observed. In patients with cystinuria, recurrent obstructive uropathy are at high risk for developing chronic kidney disease (CKD). It is therefore necessary to educate patients about this disease, and monitor patients adequately to assess the effectiveness of treatment for preventing CKD.
