Bilateral Renal Shutdown: A Rare Case of Reflex Anuria Causing Acute Kidney Injury.

BACKGROUND Reflex anuria is a rare, underrecognized cause of acute kidney injury (AKI), marked by abrupt cessation of urine output following irritation or trauma to the urinary tract or adjacent pelvic organs. Because of its rarity and diagnostic complexity, it is frequently overlooked in the postoperative setting. CASE REPORT We present the case of a 68-year-old woman who developed anuria and elevated serum creatinine 24 hours after laparoscopic hysterectomy and sacrocolpopexy for uterovaginal prolapse. Imaging and cystoscopy with bilateral retrograde pyelography revealed no obstruction or injury. Other etiologies such as acute tubular necrosis and acute interstitial nephritis were considered less likely based on her clinical presentation, absence of risk factors, and timing of renal injury. Renal biopsy was performed but was non-diagnostic due to performing medullary sampling only. Corticosteroids were briefly administered for possible rapidly progressive glomerulonephritis but discontinued when no clinical improvement was observed. Urine output and renal function improved with supportive care. Follow-up 2 weeks later in the clinic showed the serum creatinine had normalized to baseline levels. Based on the temporal association with surgery and exclusion of alternative causes, reflex anuria was deemed the most likely diagnosis. CONCLUSIONS This case serves as a reminder that reflex anuria is an important cause of AKI after pelvic surgery and highlights the need for structured renal monitoring during the perioperative period.