Bilateral hydronephrosis with non-oliguric renal failure
93 y old man with PMH of prostate cancer successfully treated in another state lost to follow up for about 2 years, when he moved out of the state. Found to have elevated creatinine (increased from baseline of 1.5 4 months prior to 3.3 on presentation) on routine blood work with further investigation shooing b/l hydronephrosis on renal ultrasound. This asymptomatic patient with unknown duration of obstructive uropathy was admitted and no other obvious etiology was found for the worsening renal failure. Foley was inserted without difficulty, and patient was nonoliguric. Nephrostomy tubes were considered unnecessary. Patient discharged after initiating anti-androgen therapy for prostate cancer. Treatment started for prostate cancer with PSA trending down but no improvement in creatinine.
What would be the best next step?
1. Repeat US to re-assess the b/l hydronephrosis
2. Reconsider decision for nephrostomy tubes
3. IV pyelogram to asses for ureteral obstruction and possible stents
4. Check viability and function with MRA
5. Check Viability with DMSA scan
6. None of the above