An unusual case of urinary ascites presenting as postoperative acute oliguric renal failure

Arunkumar, K.; Selvakumar, Easwaran

doi:10.7869/tg.2012.97

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…However, ensuring adequate drainage of the urinary ascites fluid via paracentesis and the placement of a Foley catheter can help to improve the patient's symptoms and normalize the serum creatinine level. The serum creatinine level usually returns to normal within 48 hours (2,5,6,13,14,16,17). Accordingly, the serum creatinine level in our patient quickly returned to normal following the insertion of a urinary catheter, and the ascites subsequently resolved.…”

Section: Discussionmentioning

confidence: 50%

Pseudo-acute Renal Failure due to Intraperitoneal Urine Leakage

Zhou¹,

Ying²,

Feng³

2015

Intern. Med.

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Ascites, oliguria and vomiting with an increasing serum creatinine level are often observed in patients with acute renal failure. However, these symptoms are also noted in individuals with intraperitoneal urinary leakage. Bladder rupture without a history of obvious trauma is sometimes mistaken for acute renal failure. We herein report a case of bladder perforation resembling acute renal failure in which the presentation was delayed until the patient began to experience symptoms of urinary ascites. The diagnostic dilemma associated with the rarity of this condition and possible aetiologies are discussed.

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Section: Discussionmentioning

confidence: 50%

Pseudo-acute Renal Failure due to Intraperitoneal Urine Leakage

Zhou¹,

Ying²,

Feng³

2015

Intern. Med.

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“…In addition to abdominal trauma, pseudo-renal failure has been reported in the literature due to bladder perforation following laparoscopic surgery [ 1 ], bladder diverticulum perforation [ 7 ], bladder infection [ 9 , 10 ] and neoplasmic invasion [ 11 ]. Spontaneous perforation has also been associated with radiotherapy for bladder tumours [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Pseudo-Renal Failure in the Context of Traumatic Bladder Rupture

Newman¹,

Nityanandan²,

Smyth³

2022

Cureus

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The bladder is both an intraperitoneal and extraperitoneal structure. Its anatomical position increases its risk of rupture. The resultant urine leak or extravasation can be intraperitoneal, extraperitoneal, or even both-with the former leading to more sinister outcomes. Intraperitoneal bladder rupture can lead to urinary ascites which along with anuria and abdominal pain, can present with an apparent abrupt decline in renal function as the creatinine-rich products diffuse across the peritoneal membrane. Glomerular filtration rate, a measure of kidney function is related to the levels of serum creatinine. Clinicians can therefore misdiagnose their patient with acute kidney injury when the serum creatinine is elevated as a consequence of urine being present in the peritoneal space. This is a case report of a 62-year-old male with pseudo-renal failure following intraperitoneal bladder rupture after a fall face-forwards three hours previously. The fall was due to icy conditions outside and no preceding symptoms were reported. He presented to the Accident and Emergency department with abdominal pain and no other positive symptoms. The patient had a good World Health Organisation (WHO) performance status with a background of hypertension, diabetes, and hypercholesterolemia. The bedside examination of the patient revealed a distended, abdomen with peritonitis. There were no signs of urogenital trauma. Blood testing revealed a low estimated glomerular filtration rate (eGFR) and raised creatinine (eGFR of 7 millilitres/minute and creatinine of 658 micromoles/litre). Computerised tomography examination of the abdomen and pelvis (CTAP) revealed free fluid within the peritoneal cavity and an irregular bladder wall. A CT cystogram and consultation with urology led to the diagnosis of intraperitoneal bladder rupture. The patient’s renal function from an initial set of blood tests was reduced. This was not a true impairment in renal function but rather a complication secondary to extravasation of urine in the intraperitoneal space, ie., pseudo renal failure. This supposed impairment in renal function had numerous implications. It affected the choice of antibiotics; amoxicillin and gentamicin were given at a reduced dose due to the patient’s renal function and the patient was prepared for operation theatre. The patient's blood creatinine was falsely elevated at 658 micromoles/litre due to the diffusion of creatinine from the free urine in the peritoneal space into the blood. This painted a false image of renal failure and protracted the clinical decision-making process. Relatively simple measures like an ascitic tap could have helped to differentiate this from a true acute kidney injury and could have resulted in quicker and more effective treatment of this patient. The patient went on to have bladder repair under urology. His follow-up cystogram four weeks post-operation did not show any leak.

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A marked elevation in serum creatinine/cystatin C ratio may indicate pseudo-acute kidney injury due to urinary ascites: a case report and literature review

Jiang,

Huang,

Zeng

et al. 2023

BMC Nephrol

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Background Urinary ascites represents a scarcely observed pseudo-acute kidney injury in clinical settings. Protracted or missed diagnosis may hold grave ramifications for patient outcomes. Case presentation We reported a case involving an elderly female patient experiencing pseudo-acute kidney injury accompanied by ascites, wherein her renal dysfunction persisted despite medical intervention and hemodialysis. Urinary ascites was identified via a methylene blue test and by contrasting creatinine levels in serum and ascites. This patient’s kidney function was multiple typified by a marked elevation in serum creatinine/Cystatin C ratio (> 2 L/dL), potentially serving as a clue for the clinical diagnosis of pseudo-acute kidney injury engendered by urinary ascites. Conclusions This case suggested the potential diagnostic value of an asynchronous increase in serum creatinine and serum CysC (or an increased ratio of blood creatinine to blood CysC) in patients with pseudo-acute kidney injury.

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An unusual case of urinary ascites presenting as postoperative acute oliguric renal failure

Cited by 3 publications

References 5 publications

Pseudo-acute Renal Failure due to Intraperitoneal Urine Leakage

Pseudo-acute Renal Failure due to Intraperitoneal Urine Leakage

Pseudo-Renal Failure in the Context of Traumatic Bladder Rupture

A marked elevation in serum creatinine/cystatin C ratio may indicate pseudo-acute kidney injury due to urinary ascites: a case report and literature review

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