Bilateral Obstructive Uropathy From a Large Uterine Fibroid Causing Severe Renal Impairment: A Case Report

Obstructive uropathy from uterine fibroids causing renal impairment has been reported in the literature but appears to be rare, with no definitive guidelines for management. We present a case of a 33-year-old Black female G0P0 with the incidental finding of a posterior cul-de-sac fullness found on routine physical examination. A follow-up ultrasound revealed a large posterior fibroid measuring 19.5 cm. At her follow-up visit, an in-depth history revealed heavy menstrual bleeding and chronic urinary frequency. Subsequent evaluation revealed a creatinine level of 4.0 mg/dL, new-onset hypertension, and severe bilateral hydronephrosis secondary to bilateral ureteral obstruction from the fibroid. Bilateral percutaneous nephrostomy tubes were placed for renal decompression prior to surgery with improvement in her creatinine to 2.9 mg/dL. The fibroid was successfully removed in its entirety via open abdominal myomectomy. Six weeks after surgery, her creatinine level decreased to 1.7 mg/dL but still remained above her baseline of 0.6 mg/dL, indicating some element of irreversible kidney damage. This case highlights the need for clinicians to maintain a degree of suspicion for obstructive uropathy in patients with large uterine fibroids, especially in patients with urinary symptoms and hypertension. This case also highlights the need for clinicians to identify and practice close surveillance for large uterine fibroids, given their potential to cause urinary tract obstruction that can progress to severe renal impairment.