Percutaneous nephrostomy performed by a nephrologist in a resource-limited public hospital: a case report

Background Percutaneous nephrostomy (PN) is a well-established minimally invasive procedure for the decompression of the obstructed urinary tract, traditionally performed by urologists or interventional radiologists. In medium-sized public hospitals where these specialists are often unavailable, delays in urinary drainage may worsen clinical outcomes, prolong dialysis dependence, and postpone the initiation of oncologic therapies. This report describes a successful case of percutaneous nephrostomy performed by a nephrologist in a public hospital without urological or interventional radiology coverage, highlighting the feasibility and safety of the procedure in emergency conditions. Case presentation A 65-year-old man presented with a two-month history of weight loss and poor appetite. Laboratory tests revealed markedly elevated nitrogenous waste products. Point-of-care ultrasonography (POCUS) demonstrated severe bilateral hydronephrosis, confirmed by abdominal computed tomography (CT), which also showed irregular thickening of the posterior bladder wall suggestive of neoplasia. Due to acute worsening of renal function, urgent haemodialysis was initiated. In the absence of available specialists and with delays in state-regulated referral, the nephrologist performed an emergency percutaneous nephrostomy. Using image guidance, an ultrasound-guided puncture was performed, followed by hydrophilic guidewire insertion under fluoroscopy, progressive dilation, and placement of a 10Fr pigtail catheter. Pre- and post-procedure images documented effective decompression of the collecting system. The patient showed marked clinical and biochemical improvement, recovery of diuresis (2,200 mL/24 h), and discontinuation of dialysis. He remains under outpatient oncologic follow-up. Conclusions This case demonstrates that trained nephrologists can safely perform percutaneous nephrostomy in resource-limited settings, reducing delays in urinary decompression and improving outcomes in obstructive acute kidney injury. Expanding procedural competence within nephrology represents a promising strategy to enhance patient care in public hospitals.