Dramatic reversal of severe left ventricular dysfunction after percutaneous nephrostomy in a patient with bilateral impacted ureteral stones

A 62-year-old woman presented with 3 months of progressive fatigue without fever or flank pain. Brain natriuretic peptide (BNP) levels were markedly elevated (12 000 pg/mL), with normal C-reactive protein and procalcitonin levels. Chest radiography revealed a cardiothoracic ratio of 61%, and echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of 24%. Computed tomography demonstrated bilateral impacted ureteral stones with severe hydronephrosis. Retrograde ureteral stenting was unsuccessful because the contrast agent failed to pass through the stones, and staged bilateral percutaneous nephrostomies were performed. Symptoms rapidly improved after renal decompression. Three months later, the cardiothoracic ratio improved, and the ejection fraction had recovered to 73%, while BNP gradually decreased and normalized by 4 months. No infectious episodes occurred during this period. Thus, non-infectious bilateral urinary obstruction can cause profound but reversible cardiac dysfunction through volume dysregulation or neurohumoral activation, and early decompression may prevent prolonged impairment.