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Acute renal failure due to bilateral pieloureteral stone impaction in a 10-month-old boy.
[cystinuria]
Urolithiasis
(
UL
)
can
present
with
its
classic
signs
and
symptoms
,
such
as
flank
or
abdominal
pain
and
gross
hematuria
.
However
,
atypical
complaints
can
be
more
common
in
younger
children
.
We
report
here
a
case
of
bilateral
ureteropelvic
junction
(
UPJ
)
stones
in
a
10
-
month
-old
boy
who
only
showed
nonspecific
symptoms
at
the
time
of
presentation
.
The
initial
blood
test
revealed
renal
failure
(
serum
creatinine
3
.
4
mg
/
dl
)
,
hyperkalemia
(
6
.
4
mEq
/
l
)
,
hyperphosphoremia
(
9
.
4
mEq
/
l
)
and
mild
metabolic
acidosis
.
Medical
treatment
for
electrolyte
disorders
was
started
.
The
ultrasonography
revealed
impacted
stones
in
both
ureteropelvic
junctions
.
A
pigtail
catheter
was
placed
in
each
ureter
.
High
urine
flow
was
promptly
achieved
after
the
pigtail
procedure
,
and
the
serum
creatinine
level
dropped
quickly
from
4
.
5
to
0
.
32
mg
/
dl
.
Quantitative
determination
of
urinary
amino
acids
by
ion
exchange
chromatography
showed
high
cystine
levels
of
8
.
43
mmol
/
g
creatinine
.
Outpatient
follow-up
was
scheduled
every
3
months
to
monitor
patient
compliance
with
potassium
citrate
.
In
the
first
6
months
,
the
patient
underwent
three
febrile
urinary
tract
infections
(
UTIs
)
.
Since
both
pigtail
catheters
were
removed
,
he
has
been
free
of
UTIs
and
stones
.
Our
case
emphasizes
the
need
for
considering
UL
in
infants
who
complain
with
unclear
signs
,
because
UL
can
only
show
nonspecific
symptoms
in
children
younger
than
1
year
old
.
Since
cystinuria
can
cause
loss
of
renal
function
due
to
urinary
system
obstruction
and
UTI
,
an
early
diagnosis
and
a
close
follow-up
are
the
key
to
achieving
the
best
long
-term
outcome
.