Acute Kidney Injury After Double-J Stent Placement in a Diabetic Patient with Multiple Comorbidities: A Case Report

Background : Acute kidney injury is considered a potential rare complication of Ureteral stent placement, but it can happen, especially in patients with multiple comorbidities. Case Presentation: We report a case of a 71-year-old male patient with a history of diabetes mellitus (DM), hypertension (HTN), and dyslipidemia, who was also suffering from ischemic heart disease treated by percutaneous coronary intervention (PCI) and stenting two months ago. The patient presented with obstructive pyelonephritis, experiencing stabbing flank pain and hematuria for 4 days. Initial investigations revealed obstructive uropathy due to a left ureteric stone, and laboratory results indicated a creatinine level of 3.1 mg/dL. Despite ongoing prasugrel (antiplatelet) medication, an urgent double-J (DJ) stent placement was attempted but failed due to severe obstruction. Hence, the plan was to discontinue prasugrel and start enoxaparin for 5 days, during which time he received intravenous antibiotics and fluids, showing progressive improvement in creatinine levels. Following the second DJ stent placement surgery, the patient experienced worsening bilateral flank pain, nausea, vomiting, and a significant increase in creatinine, peaking at 4.31 mg/dL. The patient had full management inclusive of volume and electrolyte assessment. A gradual improvement in kidney function was observed over the following weeks. Conclusion: This case highlights the interplay between stent placement, antiplatelet management, and AKI risk in a diabetic elderly patient, by which we hope to underscore the need for careful perioperative planning and monitoring.