Abstract: FR-PO016

AKI Due to Bladder Rupture After a Fall

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Long, Brad, University of Utah, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah, Salt Lake City, Utah, United States
Background

Urinary bladder rupture is usually associated with high impact trauma and is rarely seen in milder trauma. We present a case in which a patient sustained a ground level fall leading to bladder rupture and acute kidney injury.

Methods

A 68 year old male with CKD stage III due to diabetic nephropathy with baseline creatinine of 2.5-2.9mg/dL presented to the emergency department after falling onto his walker after having cocktails with friends. The fall resulted in brief loss of consciousness and right wrist injury. On presentation he had exquisitely tender abdomen and nausea and emesis.

Foley catheter was placed resulting in drainage of gross hematuria. Initial labs showed acute kidney injury with creatinine of 6.3mg/dL, serum potassium 7.2meq/L, and serum bicarbonate of 16mmol/L. He had no elevation in anion gap or serum lactate. The hyperkalemia and acidosis were not improved with boluses of IV sodium bicarbonate and furosemide. CT abdomen/pelvis revealed extraperitoneal bladder rupture that was further characterized on CT cystography.

Results

The patient was taken emergently to the operating room emergently by the consulting urology service for exploratory laparotomy and repair of the bladder. He did require a single treatment of hemodialysis for hyperkalemia. Following repair of the bladder, his renal function rapidly returned to baseline and the hyperkalemia and metabolic acidosis resolved.

Conclusion


Traumatic bladder injury resulting in obstructive uropathy is a cause of AKI that should be excluded in patients suffering even mild trauma. A full bladder is more susceptible to rupture than an empty bladder. In this setting, a low-impact event can produce dramatic internal injury. CT cystography provides accurate and rapid identification of bladder injuries. Prompt surgical management is crucial.


CT cystogram demonstrating extraperitoneal bladder rupture