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Acute Kidney Injury Secondary to Acute Urinary Retention in an 87-
Year-Old Female with Prolonged Poor Oral Intake in Hospital
National Guido Valadares, Timor Leste on May 2026: A Case Report
Mateus Pinheiro
1,2
, Lidia Soares Ximenes
1
, Giovanni Otipaga Pereira Soares
3
1
Internal medicine department, Hospital national Guido Valadares (HNGV), Dili, Timor-Leste
2
Family medicine program integrated (FMPI), University of Timor Lorosae (UNTL), Dili, Timor-Leste
3
Nephrology unit, Hospital National Guido Valadares, Dili, Timor-Leste
DOI:
https://doi.org/10.51583/IJLTEMAS.2026.150600270
Received: 15 July 2026; Accepted: 20 July 2026; Published: 03 August 2026
ABSTRACT
Acute kidney injury (AKI) is a common medical emergency in elderly patients and is associated with significant
morbidity and mortality. Postrenal obstruction accounts for approximately 5–10% of AKI cases but is more
common among older adults. We report the case of an 87-year-old woman who presented with a 10-day history
of inability to eat and drink, progressive weakness, abdominal distension, and inability to pass urine.
Examination revealed a markedly distended bladder consistent with acute urinary retention. Laboratory
investigations demonstrated severe AKI and Urinary Tract infection (UTI). Prompt bladder catheterization
drained a large volume of urine, resulting in rapid clinical improvement and gradual recovery of renal function.
This case highlights the importance of considering urinary retention as a reversible cause of AKI in elderly
women, where delayed diagnosis may lead to permanent renal damage.
Keywords: Acute kidney injury, acute urinary retention, obstructive uropathy, elderly female, postrenal AKI,
bladder outlet obstruction, dehydration; Timor-Leste; resource-limited setting
INTRODUCTION
Acute kidney injury (AKI) is a sudden decline in kidney function resulting in the accumulation of metabolic
waste products and disturbances in fluid, electrolyte, and acid-base balance (1). According to the Kidney
Disease: Improving Global Outcomes (KDIGO) guideline, AKI is diagnosed by an increase in serum creatinine,
a reduction in urine output, or both (1). AKI is classified into prerenal, intrinsic renal, and postrenal causes, with
postrenal obstruction accounting for approximately 5–10% of all cases but occurring more frequently among
elderly patients (2,3).
Urinary retention is a relatively uncommon condition in women because of their shorter urethra and lower
prevalence of bladder outlet obstruction compared with men (4). However, advanced age, pelvic organ prolapses,
neurogenic bladder, diabetes mellitus, medications with anticholinergic properties, severe constipation, and
detrusor underactivity increase the risk of urinary retention in elderly women (4,5). If left untreated, urinary
retention may lead to obstructive uropathy, hydronephrosis, urinary tract infection, electrolyte disturbances, and
AKI (3,5).
Early recognition of obstructive nephropathy is essential because renal dysfunction is often reversible following
prompt decompression of the urinary tract (2,6). We report the case of an 87-year-old woman presenting with
prolonged poor oral intake, acute urinary retention, UTI and severe AKI that improved after bladder
catheterization, rigorous fluid and monitoring and Intravenous antibiotics
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Case Presentation
An 87-year-old female presented to the emergency department with progressive generalized weakness and
reduced consciousness after ten days of poor oral intake. According to family members, she had eaten and drunk
very little during this period. She had also been unable to pass urine for last ten days, with progressive lower
abdominal swelling and painful.
She denied fever, diarrhea, vomiting, or recent trauma. Her medical history included hypertension which
diagnosed in 2019 and she regular medication Amlodipine 10 mg peroral nocte to control her blood pressure,
and she had no previous history of chronic kidney disease and urine retention in the past.
On examination, elderly female appeared dehydrated and lethargic but her consciousness was fully conserved
but slightly confusion with Glascow coma scale 14/15 (open eyes:4 motor response:5 and verbal response 5)
Vital signs
Blood pressure: 110/70 mmHg
Pulse: 102 beats/minute
Respiratory rate: 20 breaths/minute
Temperature: 36.8°C
Oxygen saturation: 97% on room air
Physical examination revealed: dry mucous membranes, reduced skin turgor, markedly distended suprapubic
region and Tender palpable urinary bladder suggested for Cystitis. There was no costovertebral angle tenderness
to suggest for pyelonephritis. No bipedal edema of the legs. Her physical examination on other systems was
within normal ranges. A Foley urinary catheter was inserted immediately, draining approximately 2,000–2,500
mL of dark concentrated urine.
Investigations
Initial and frequent follow up laboratory findings demonstrated on the table.
Investigation
Result
Normal Ranges
Initial test
08 /06/2026
Follow up test
11/06/2026
Out patient
follow up test
30/06/2026
Creatinine
500.2 umol/L
51.0 umol/L
40 umol/L
<110 umol/L
Blood Urea
Nitrogen
42.8 mmol/L
3.5 mmol/L
3 mmol/L
3.0-8.0 mmol/L
Potassium
4.6 mmol/L
3.2 mmol/L
3.6 mmol/L
3.5-5.3 mmol/L
Sodium
134.6mmol/L
128.0 mmol/L
135 mmol/L
135-145 mmol/L
Bicarbonate
(CO2)
11 mmol/L
23 mmol/L
24 mmol/L
21-31 mmol/L
Hemoglobin
124.4 g/L
124 g/L
125g/L
120-150g/L
White blood
cells
11.7 X10⁹/L
10.5x10⁹/L
9.0x10⁹/L
3.5-11.0 x10⁹/L
eGFR
6.31
ml/min/1.73m
2
90
ml/min/1.73m
2
94
mL/min/1.73m
2
>90 ml/min/1.73m
2
Table:1
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Urinalysis showed:
Present of Nitrite, leucocyte esterase, white blood cells, few bacteria were identified and cloudy urine
appearance. No Blood, no cast, no crystal, glucose and protein was negative
Urine culture: Reported of no growth after 5 days.
Renal ultrasonography revealed:
Diffuse bladder wall thickening measured 4 mm with urinary bladder distended, irregularity wall with increased
vascularity and floating low level of echoes. Bilateral hydronephrosis but no renal calculi, no ureteral stone, no
bladder stone no urethral stone and no renal masses were identified on abdominal ultrasonography.
CT abdomen Pelvis simple
CT scan abdomen/ pelvis simple revealed: no kidneys stone no ureteric stone, no bladder stone, no urethral stone,
hydronephrosis bilateral kidneys, there was no pelvic or abdominal mass was identified. The liver, spleen,
pancreas are normal in size, contour and attenuation with no focal lesion identified. The remaining visualized
abdominal organs are unremarkable.
Diagnosis
Based on the history, physical examinations, laboratory and imaging results demonstrated the patient was
diagnosis with:
1.Acute kidney injury/AKI as urea and creatinine were markedly abnormal and eGFR 6.31 ml/ min/1.73m
2
(AKI
KDIGO stage 3)
2. Culture negative urinary tract infection (UTI) / Cystitis
3. Acute urinary retention
4. Postrenal obstructive nephropathy
5. Dehydration secondary to prolonged poor oral intake
Management
This patient was managed as following:
1. Immediate bladder decompression with Foley catheter draining dark concentrated urine 2000-2500 ml in the
urine bag
2. Intravenous isotonic fluids normal saline 0.9 % 500 ml bolus was given than maintenance 15-20 mL/kg/day
3. Noso-gastric tube inserted for feeding and fluid administration for rehydration and limited Intravenous fluid
to avoid fluid overload and complication for elderly patient.
4. Intravenous antibiotics Ceftriaxone 1 gr twice daily for 7 days as per local antibiotics guidelines.
5. Strict monitoring of urine output and control fluid administration from intravenous to avoid fluid overload
6. Followed up renal function monitoring result to adjust fluid management.
7. follow up electrolytes test for correction
8. Avoidance of nephrotoxic medications, Diclofenac intramuscular injection for pain was stopped immediately.
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9.Nephrologist consultation was done and advice for repeat renal function test after adequate hydration in next
24 hours.
After rigorous treatment given to the patient and following catheterization, urine output improved markedly
2500- 3000 ml was recorded immediately and continue with good urine Out-put over 24 hours. Serum creatinine
and blood urea nitrogen progressively decreased over the following days and normalized at repeated test on third
day, accompanied by improvement in appetite and mental status. She has been sitting with help and going to
toilet with support because her elderly age but clinical much stable.
Outcome and Follow-up
The patient demonstrated gradual recovery of renal function which demonstrated on follow up laboratories
results showed on the table (table:1) with urea and creatinine remains normal and eGFR was within normal
range for 87 years old female and normal of urine output from 2000-2500 ml per 24 hours draining from
indwelling catheter.
She was discharged after stabilization and completion of 7 days Intravenous ceftriaxone for complicated urinary
tract infection/ Cystitis in elderly patient following local antibiotic guidelines. She was discharged home with:
1.Indwelling urinary catheter because she had repeated retention in the ward after indwelling was removed and
Indwelling catheter changing every two weeks at out-patient department
2. Follow-up at Nephrologist out-patient with repeat renal function test which normal after few weeks of
discharged from hospital, renal function and eGFR as shown on the table 1 above.
3. Naso gastric for feeding and fluid administration because patient did not eat and drink per oral which is
common in elderly patient and nasogastric tube will be change every month at out- patient department. The
patient was stable throughout subsequent regular out-patient follow up with renal function and eGFR
maintaining normal.
DISCUSSION
Postrenal AKI results from obstruction to urinary flow, leading to increased intratubular pressure, reduced
glomerular filtration rate, decreased renal perfusion, and tubular injury (2,6). Experimental studies have
demonstrated that prolonged obstruction produces inflammatory changes, tubular atrophy, and interstitial
fibrosis, emphasizing the importance of early diagnosis and intervention. This case was classified into AKI
KDIGO stage 3 caused by postrenal obstructive to urinary flow. She had severe oliguria with creatinine 500.2
ummol/L, urea 42.8 mmol/L and eGFR 6.31 ml/min/1.73m
2
which need for urgent dialysis, however immediate
action taking through Indwelling catheter had resolved urinary retention by drained out 2,000 -2,500 ml of urine
and rigorous rehydration reversed patient from worsening AKI stage 3 and had stopped the patient from urgent
dialysis (7).
Although urinary retention is predominantly observed in older men, it should not be overlooked in elderly
women, particularly those with neurological disease, pelvic organ prolapses, chronic constipation, previous
pelvic surgery, diabetes mellitus, or medication-induced bladder dysfunction (4,5). Elderly patients frequently
present with nonspecific symptoms such as anorexia, confusion, lethargy, abdominal discomfort, or reduced
urine output rather than classic lower urinary tract symptoms, making diagnosis challenging (5).
In the present case, the patient had ten days of poor oral intake and inability to void with urine output was nil for
several days at home resulting in combined prerenal dehydration and postrenal obstruction. The palpable
distended bladder prompted immediate bladder catheterization, which drained a large volume of urine and was
followed by gradual recovery of renal function. This clinical course is consistent with previous reports
demonstrating that timely relief of urinary obstruction can reverse renal impairment when irreversible nephron
damage has not yet occurred (2,6).
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After bladder decompression, clinicians should monitor patients for post-obstructive diuresis, characterized by
excessive urine output that may result in dehydration, hypovolemia, and electrolyte disturbances if not managed
appropriately (3,8). Close monitoring of fluid balance, electrolytes, and renal function is therefore recommended
and proper investigation should be carried out to identified the causes of postrenal obstruction urinary retention
in elderly female patient.
This case highlights the importance of considering urinary retention in elderly women presenting with AKI,
particularly when physical examination reveals a distended bladder. A simple bedside bladder examination and
timely urinary catheterization may prevent permanent kidney injury and significantly improve patient outcomes
as it is shown in this case report. Acute kidney injury (AKI) is a significant and under-recognized cause of
morbidity among hospitalized patients in low- and middle-income countries, including Timor-Leste, where
delayed presentation, limited access to diagnostic imaging, and shortages of specialist nephrology and urology
services remain ongoing challenges (1,2). In such resource-limited settings, AKI is often related to dehydration,
infections, and late presentation of reversible conditions (2,3).
Although urinary tract infections and volume depletion are commonly reported contributors to AKI in the region,
postrenal AKI due to acute urinary retention in elderly women is rarely documented in the medical literature of
Timor-Leste (3,4). This may reflect underdiagnosis rather than true rarity, as bedside bladder assessment and
early catheterization may not always be systematically performed in elderly patients presenting with non-specific
symptoms such as weakness, anorexia, or confusion. UTI in 87 years old female still common related to age
changes, incomplete bladder emptying because of reduced muscle strength which leading to increased post-void
residual urine (4). This is what happen to the case report with poor oral intake for ten days leading to dehydration
and unable to past urine in elderly because of decreased muscle strength causing AKI and UTI/ Cystitis.
This case emphasizes the importance of careful clinical examination in low-resource environments. A simple
bedside finding of a distended urinary bladder allowed prompt catheterization, immediate decompression, and
recovery of renal function without the need for advanced imaging or renal replacement therapy (1,10). Such
findings highlight the critical role of basic clinical skills in improving outcomes in settings with limited
diagnostic infrastructure.
To our knowledge, this may be among the first reported cases from Timor-Leste describing AKI secondary to
acute urinary retention and UTI/ Cystitis in an elderly female patient. Reporting such cases is important to raise
awareness among clinicians in Timor-Leste regarding reversible causes of AKI and to encourage routine
evaluation for urinary retention in elderly patients presenting with oliguria or unexplained renal impairment
(9,11).
CONCLUSION
Acute kidney injury secondary to acute urinary retention is a potentially reversible condition that requires early
recognition and timely intervention. This case from Hospital Nacional Guido Valadares, Timor-Leste highlights
the importance of thorough clinical assessment, including evaluation of hydration status and bedside bladder
examination, particularly in elderly patients presenting with non-specific symptoms such as weakness, poor oral
intake, and reduced urine output.
In a resource-limited setting such as Timor-Leste, where access to advanced diagnostic investigations were
limited, careful history taking, physical examination, basic laboratory testing, and early urinary catheterization
remain essential tools for preventing complications and improving outcomes. Prolonged poor oral intake and
delayed presentation may increase the risk of severe AKI among vulnerable elderly patients.
This case emphasizes the need to strengthen awareness among healthcare workers regarding post-renal causes
of AKI, improve early screening for urinary retention in elderly patients, and promote timely management
strategies to reduce avoidable morbidity and mortality in Timor-Leste.
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s)
has/have given his/her/their consent for his/ her/their images and other clinical information to be reported in the
journal. The patients understand that their names and initials will not be published, and due efforts will be made
to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest
Authors:
Mateus Pinheiro: email:
mateus41276@gmail.com
Lidia Soares Ximenes: lidiasoaresximenes@gmail.com
Giovanni Otipaga Pereira Soares: email: otipagavasha6187@gmail.com
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