Clinical Mysteries • Nephrology
The Kidney Injury That Wasn’t Sepsis
The presentation
Creatinine rose during an infection, but urine output collapsed despite haemodynamic recovery.
The first explanation was plausible, but the pattern did not fully fit. A deliberate second look focused on physiology, medication/exposure history, serial observations and the clue that the initial diagnosis could not explain.
The turn
A distended bladder and hydronephrosis exposed a reversible post-renal cause.
Diagnosis
Obstructive uropathy
Why this case matters
Always ask whether urine can get out.
Take-home message: When the clinical course contradicts the working diagnosis, stop escalating the same treatment and rebuild the problem from first principles.