Child passed away 72 hours into admission. Case 5 Twelve-year-old H. M. was referred to KATH from a district hospital with left flank pain and passage of scanty urine for 4 days. Epigenetic inhibitor She had been given IV fluids and IV frusemide at the district hospital on account of the oliguria yet urethral catheterisation yielded no urine. The flank pain had worsened subsequently with child wailing loudly that prompted urgent referral to KATH. Patient had lived in Krachie

near Akosombo for first 8 years of life where she experienced recurrent terminal haematuria for 4 yrs. Essential findings on physical examination were: BP 170/120mmHg; the rest of cardiovascular examination was normal. Chest was clinically clear. There was tenderness in the left lumbar region but the kidneys and bladder were not palpable. There was no peripheral oedema. Accompanying lab results showed Hb 9.7g/dl., MCV 75 fl, serum creatinine 1,947µmol/l, Na+ 128mmol/l, K+ 7.3mmol/l; urinalysis Fulvestrant nmr of protein 2+, blood 2+, pus cell 6–8/HPF, RBC >20/HPF, S. haematobium ova 2+; urine culture was negative. Salbutamol nebulisation 5mg hourly and sodium polysterene (kayexalate) per rectum were instituted to control the hyperkalaemia. IV hydralazine was started with oral amlodipine. Urethral catheter passed yielded no urine. Laboratory results

were: blood urea of 52.9 mmol/l, creatinine 2,282µmol/l, Na+ 127mmol/l and K+ 7.2mmol/l. USS showed severe bilateral hydroureteronephrosis with left peri-nephric collection. Bladder was empty with drainage

catheter in-situ. Diagnoses of acute kidney injury 2° schistosomal related obstructive uropathy, and worsening over hydronephrosis from IV fluids were made. Nephrostomy tubes were inserted into both kidneys. Urine output per nephrostomy tubes for the first 24 hours yielded 9.3mls/kg/hr. Fluid replacement in excess of 4ml/kg/hr of urine output was instituted. Patient also received full treatment with praziquantel. BP was controlled, and flank pain decreased substantially. Good recovery of kidney function was recorded three weeks after placement of the nephrostomy tubes with the following laboratory results: Three weeks into placement of nephrostomy tubes, new laboratory values of blood urea 5.8mmol/l, creatinine 93 µmol/l, Na+ 135mmol/l and 4.5 K+mmol/l were obtained. Anterograde pyelogram confirmed severe bilateral ureteral obstruction. Patient subsequently underwent bilateral ureteral reimplantation with placement of double J-stent. Intraoperative findings showed fibrotic bilateral distal ureters none of which was “passable” at the distal 2–3cm segment from the vesico-ureteric junction. Bladder wall was markedly thickened. Patient has done well postoperatively and is still being followed up. An interval IVU is planned to assess the success and patency of the distal ureters.