Seif S, Mahmoud S, El Sayad I, Bou Rizk R, Tlais M. Obstructive uropathy and acute-on-chronic kidney disease from common iliac artery aneurysm: A case report. World J Clin Urol 2026; 15(2): 120632 [DOI: 10.5410/wjcu.120632]
Corresponding Author of This Article
Mohamad Tlais, MD, Department of Internal Medicine, University of Balamand, Hazmieh, Beirut 1100, Beyrouth, Lebanon. mmtlaiss22@gmail.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
case-report
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Seif S, Mahmoud S, El Sayad I, Bou Rizk R, Tlais M. Obstructive uropathy and acute-on-chronic kidney disease from common iliac artery aneurysm: A case report. World J Clin Urol 2026; 15(2): 120632 [DOI: 10.5410/wjcu.120632]
Souad Seif, Sally Mahmoud, Imad El Sayad, Rony Bou Rizk, Mohamad Tlais, Department of Internal Medicine, University of Balamand, Beirut 1100, Beyrouth, Lebanon
Author contributions: Seif S contributed to conceptualization; Seif S, Mahmoud S, El Sayad I, Bou Rizk R, and Tlais M contributed to data collection and clinical management; Seif S and Mahmoud S contributed to literature review and writing - original draft preparation; El Sayad I, Bou Rizk R, and Tlais M contributed to writing - review and editing; El Sayad I and Tlais M contributed to supervision. All authors have read and agreed to the published version of the manuscript.
AI contribution statement: Grammarly was used only for limited translation support and minor editorial grammar correction. It was not used for scientific content generation, data analysis, or substantive writing assistance. We confirm that all intellectual content, scientific reasoning, study design, analysis, and conclusions are solely the work of the authors. The limited use of AI-assisted tools was restricted to translation and minor language editing only, in the same manner that was used in the response to the reviewers’ comments.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Mohamad Tlais, MD, Department of Internal Medicine, University of Balamand, Hazmieh, Beirut 1100, Beyrouth, Lebanon. mmtlaiss22@gmail.com
Received: March 5, 2026 Revised: April 16, 2026 Accepted: May 15, 2026 Published online: September 16, 2026 Processing time: 196 Days and 2.6 Hours
Abstract
BACKGROUND
Extrinsic ureteral compression is an uncommon but clinically significant cause of obstructive uropathy. Iliac artery aneurysms rarely present with urinary tract obstruction and may be overlooked in the differential diagnosis of hydronephrosis, particularly in patients with underlying chronic kidney disease (CKD) in whom acute-on-chronic renal deterioration may develop rapidly.
CASE SUMMARY
A 63-year-old woman with hypertension, dyslipidemia, hypothyroidism, CKD, and coronary artery disease presented with pelvic pain, decreased oral intake, and vomiting. On admission, serum creatinine was 2.7 mg/dL, representing an acute rise of 1.1 mg/dL from a documented baseline of 1.6 mg/dL within the preceding seven days, fulfilling Kidney Disease: Improving Global Outcomes criteria for acute kidney injury superimposed on CKD. Noncontrast computed tomography (performed without intravenous contrast given the acute renal deterioration) revealed a large right common iliac artery aneurysm measuring 4.8 cm at its maximal diameter, compressing the right ureter at the pelvic brim with severe right-sided hydronephrosis and hydroureter. Percutaneous nephrostomy was performed, achieving successful decompression. Serum creatinine improved to 1.9 mg/dL by post-procedure day 4, establishing a new functional baseline. Multidisciplinary evaluation by urology, vascular surgery, nephrology, and cardiology was performed. Endovascular aneurysm repair was successfully carried out eight weeks after discharge, following cardiac optimization. The nephrostomy tube was removed twelve weeks after insertion, with serum creatinine stable at 1.8 mg/dL at three-month follow-up.
CONCLUSION
Common iliac artery aneurysm is a rare but important cause of obstructive uropathy and acute kidney injury superimposed on CKD. Early vascular imaging, prompt urinary decompression, and multidisciplinary coordination are essential to prevent irreversible renal impairment and to facilitate timely definitive aneurysm repair.
Core Tip: Common iliac artery aneurysm is a rare but clinically significant cause of extrinsic ureteral compression leading to obstructive uropathy and acute kidney injury. In patients presenting with unexplained hydronephrosis and renal dysfunction, vascular etiologies should be considered, particularly when conventional causes are absent. Noncontrast imaging may identify obstruction in the setting of acute kidney injury, while magnetic resonance angiography can provide further vascular characterization. Early decompression and coordinated multidisciplinary management are critical to preserving renal function.
