DOI: https://doi.org/10.36347/sasjm.2025.v11i10.018

Pages: 1039-1042

Background: Uterine leiomyomas (fibroids) are the most common benign gynaecological tumours, often asymptomatic but capable of causing significant complications depending on their size and location. Although rare, large fibroids can cause obstructive uropathy, leading to severe renal dysfunction. Case Presentation: In this study, we report the case of a 39-year-old Black-British female who presented with a 6-month history of lower abdominal pain and menorrhagia. Her initial blood tests revealed severe renal impairment (eGFR 17 mL/min/1.73m²), because of which she was admitted to emergency department, but no imaging was performed. She was discharged home and was lost to follow-up for 4 months. Upon re-presentation, a CT scan revealed marked bilateral hydronephrosis secondary to a significantly enlarged fibroid uterus (12.6 × 11.8 × 18.1 cm). She underwent urgent bilateral nephrostomy followed by myomectomy. Despite clinical improvement, she remained under nephrology care for chronic kidney disease. This case highlights the potential for uterine fibroids to cause significant renal impairment through mechanical ureteric obstruction. Conclusion: Clinicians should maintain a high index of suspicion for structural causes of unexplained renal impairment in women presenting with pelvic symptoms. Prompt imaging, timely diagnosis, and multidisciplinary management are critical to improving outcomes and preventing long-term renal sequelae.