Author: Lotte Weenink, Faisal Faruqi / Editor: Sarah Edwards / Codes: HP2, SLO1 / Published: 24/10/2022

A middle-aged male attends the Emergency Medicine (ED) feeling generally unwell with anuria and constipation for 6 days.

He has a past medical history of bilateral renal artery stenosis 15 years prior, one remaining functional kidney which has a renal artery stent. Otherwise, he is fit and well. He takes warfarin and has missed his most recent INR check in the community.

Bloods show an AKI 3, an INR of 15 with normal Hb.

Non-contrast Computerised tomography

(CT) abdomen/pelvis shows ureteric outlet obstruction with an unclear cause. There is no radiological or clinical evidence of bleeding.