Pseudo-renal failure: bladder rupture with urinary ascites

Abstract

We report a case of pseudo-renal failure caused by urinary ascites due to spontaneous bladder rupture following transurethral resection of a bladder tumour (TUR-BT). A 63-year-old man presented with 2 months of abdominal distension due to ascites. Laboratory findings showed elevated serum creatinine and hyperkalaemia. Peritoneal fluid urea, creatinine and potassium levels were greater than those in serum levels. CT scan showed partial wall thinning in the bladder wall, and cystography indicated fragility in the dome where the latest TUR-BT was performed. Pseudo-renal failure (laboratory abnormalities of acute kidney injury in the setting of normal kidney function) from urinary ascites and reverse intraperitoneal dialysis was diagnosed. Symptoms and laboratory abnormalities improved promptly with insertion of a urinary catheter. This report aims to increase recognition of urinary ascites when a patient with genitourinary surgical procedures or radiation therapy, or blunt abdominal trauma, presents with ascites and elevated creatinine simultaneously.

Regression of Renal Failure after Unilateral Simple Nephrectomy

“…This leakage may result in perirenal extravasation and eventually urinary ascites. Sometimes this situation presents as renal pseudo-failure (laboratory abnormalities of acute kidney injury in the setting of normal kidney function) [18][19][20]. In our case severe obstruction secondary to kidney stone and high intrarenal pressure may be causing perirenal urine extravasation.…”

A Foley Fallacy: A Case of Bladder Rupture after “Routine” Foley Catheter Placement

“…The AUA has stated that to diagnose bladder injury a retrograde cystography is the technique of choice, either plain film or CT cystography [9]. There is no data published regarding the best diagnostic modality for bladder injury in renal failure or oliguric patients; however Matsumura et al did report a case of renal failure with bladder rupture which was diagnosed with CT imaging [15]. In conclusion, intraperitoneal bladder rupture is difficult to assess and should be on the differential when evaluating deteriorating septic patients after Foley catheter placement, even without a history of trauma or without changes in urination.…”

Postoperative intraperitoneal bladder rupture detected by renal scintigraphy: The importance of postvoid imaging

“…[ 5 6 ] A CT examination is the most common tool in the diagnosis of bladder rupture. [ 7 ] Renal scintigraphy is not the first-line imaging modality in the diagnosis of bladder rupture; however, with unexplained laboratory values and symptoms within a postoperative patient, renal scintigraphy can play a pivotal role; postvoid and delayed phase imaging, in particular, can demonstrate sequela of a bladder rupture as well as other sequela of postsurgical complications with damage to the collecting system. A search of literature demonstrated the prior usage of renal scintigraphy with DTPA in the diagnosis of bladder rupture.…”