Clinical Obstructive Uropathy Simulating Severe Acute Kidney Injury due to Djenkolism: A Rural Case Report

Introduction. Obstructive uropathy secondary to djenkol bean intoxication is a rare but clinically significant condition encountered in Southeast Asia. Djenkolic acid can precipitate within the urinary tract and cause acute obstruction, leading to a sudden reduction or cessation of urine output. Recognition of this condition is essential, particularly in rural and resource-limited healthcare settings where access to laboratory investigations is often restricted. Case. A 24-year-old woman presented to a rural primary healthcare facility with acute urinary retention, severe bilateral colicky flank pain, and nausea. Symptoms developed after repeated consumption of raw djenkol beans over several days, exacerbated by low fluid intake. Physical examination revealed marked bilateral costovertebral angle tenderness and suprapubic pain, while initial catheterization yielded minimal urine output. Abdominal ultrasonography demonstrated bilateral hydronephrosis, confirming acute post-renal obstruction. Due to the unavailability of biochemical testing, a diagnosis of clinical obstructive uropathy simulating severe acute kidney injury (AKI) was established based on the patient's anuric presentation and characteristic exposure history. Conservative management was initiated, comprising urinary drainage, aggressive intravenous hydration, urine alkalinization, and diuretic therapy. The patient exhibited progressive clinical improvement with normalized urine output and resolution of pain, recovering fully without the need for invasive urological intervention. Conclusion. This case emphasizes the critical need to recognize djenkolism as a cause of acute obstructive uropathy in endemic regions. Even in the absence of comprehensive laboratory data, early diagnosis based on clinical assessment and basic imaging enables effective conservative management and favorable outcomes in resource-limited settings.