Inpatient Medical Director VA Palo Alto, Spinal Cord Injury/Disorder Center Santa Clara, California, United States
Case Diagnosis: Ureteropelvic junction obstruction caused by neurogenic scoliosis in SCI patient with history of congenital malrotated kidney
Case Description: Ms. JSG is a 49-year-old veteran with spinal cord injury (SCI), C7 ASIA Impaired Scale D due to a motor vehicle accident and right malrotated kidney. She has a history of nephrolithiasis, UTI, and scoliosis secondary to SCI. In May 2022, CT scan obtained for nephrolithiasis revealed new severe right-sided hydronephrosis. 3 weeks later, she presented to ED with fever and left lower quadrant pain. CT showed worsening of right hydronephrosis with right-sided peri-renal inflammation and new left hydronephrosis. Renal scan confirmed right ureteropelvic junction obstruction. 3 months later, repeat CT showed worsening right hydronephrosis and scoliosis. Patient underwent ureteral stent placement for malrotated right kidney. 4 months later, renal ultrasound confirmed sustained resolution of right hydronephrosis.
Discussions: The case demonstrated ureteropelvic junction obstruction in congenital kidney malformation due an SCI induced neuromuscular scoliosis. While renal malrotation presents as asymptomatic in patients, diagnosis is usually incidentally made through imaging studies during evaluation of abdominal pain and urinary abnormalities. Following SCI, progression occurs in spinal deformity and scoliosis due to motor control loss that hinders maintenance of an upright position. Current data and literature review on the management of neuromuscular scoliosis on congenital kidney malformation is scarce. Our patient demonstrated how the progression of scoliosis can affect the anatomical structure of the upper urinary tract, resulting in renal function decline.
Conclusions: This is a rare case of a patient with a history of a congenital kidney malrotation in which a neurogenic scoliosis secondary to a cervical SCI was worsening the renal function. Without documented case reports, prevalence of such phenomenon is unknown. Placing ureteral stents has recovered the renal function. With patients with SCI, it is important to monitor renal labs and renal ultrasound on annual evaluations.
