Abstract: TH-PO565
Taming Nephrogenic Ascites by Living Kidney Transplant in a Developing Country
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Rashid, Raja Muhammad, CPSP, Islamabad, Pakistan
- Nabi, Zahid, KRL hospital, Islamabad, Pakistan
- Ul Zahideen, Zahid, Department of Nephrology KRL islamabad, Islamabad, Pakistan
Introduction
Nephrogenic ascites is a diagnosis of exclusion and describes the refractory ascites in patients with renal failure before or after the initiation of dialysis. It’s a rare and devastating condition with an inconsistently reported incidence that is as low as 0.7%. Renal transplant is considered the most effective management and has been described predominantly in deceased donor transplants from the high income countries. In low and middle income countries, nephrogenic ascites is still a visible problem but successful management with living kidney donation is not well reported.
Case Description
45 years old male known case of ESRD was on twice weekly maintenance hemodialysis schedule since June 2010 via left brachiocephalic arterio-venous fistula, His Hypertension for the same time period was being managed by Losartan and Carvedilol. He presented with gradual abdominal swelling for last 6 months in the year 2016. There was no history of current or preceding fever, abdominal pain, altered bowel habits, jaundice, weight loss, body aches or missed dialysis sessions. He was being dialyzed twice weekly with blood flow of 300 ml/min and dialysate flow rate of 500-600 ml/min. His average Inter-dialytic weight gain had been around 2.5 kg. Examination and work up demonstrated a serum albumin of 3.7mg/dl , low SAAG and exudative lymphocytic ascites and a normal peritoneal biopsy in a well-nourished man. After exhaustive work up; cardiac, hepato-billiary, infective and other causes of ascites were appropriately excluded. Intensification of hemodialysis and ultrafiltration with intermittent paracentesis did not improve his ascites. He underwent renal transplantation by donation from his spouse with paracentesis prior to transplantation. Instant graft function and uneventful post-transplant period resulted in gradual resolution and disappearance of ascites over 2 months.
Discussion
Not all patients completely fit the usual profile for nephrogenic ascites. Our patient developed nephrogenic ascites despite adequate nutritional status, normal serum albumin, ACE inhibitors and strict compliance with the dialysis schedule. Meticulous work up is required to exclude the direct causative pathologies. Lliving kidney transplant is an effective management strategy and can be carried out with only a fractional increase in work up related cost even in low and middle income countries.