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Kidney Week

Abstract: TH-PO143

Urinary Ascites from Spontaneous Bladder Rupture: Rare Cause for Pseudo AKI

Session Information

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Sharma, Vivek, Texas A&M Univ COM, Baylor Scott & White, Temple, Texas, United States
  • Hakeem, Imtiyaz H., Baylor Scott & White Health/Texas A&M COM-HSC, Temple, Texas, United States
  • Hashim, Faris Q., Texas A&M Univ COM, Baylor Scott & White, Temple, Texas, United States
  • Goraya, Nimrit, Texas A&M Univ COM, Baylor Scott & White, Temple, Texas, United States
Introduction

Spontaneous intraperitoneal bladder rupture is a rare entity. Diagnosis can be challenging. Symptoms are non-specific and misleading which delays the diagnosis and treatment of SUBR. In the pediatric population, the leading causes of rupture in reported cases are patients with neurogenic bladders, bladder diverticulum, bladder outlet obstruction, and history of bladder augmentation surgery. Symptoms of urinary leakage into the peritoneum include abdominal pain and distension, oliguria or anuria, and elevated serum creatinine. Elevation of the creatinine from resorption of peritoneal fluid results in elevation of serum creatinine, termed as pseudo-renal failure.Measuring the creatinine of the ascitic fluid can help aid in accurate diagnosis of an intraperitoneal bladder rupture.We present an interesting case of a 13 year old boy who presented with abdominal distension and pain with rapidly rising creatinine.

Case Description

13 y.o. male with urachal cyst excision 6 years ago, presented with abdominal pain and elevated creatinine. Imaging studies revealed mild ascites. Liver morphology was reported normal. Elevation in creatinine was attributed to pre-renal etiology and was encouraged hydration.
He presented back 3 months later with increasing abdominal distension and discomfort, rapid elevation of the creatinine with hematuria. With rapid rise in creatinine and positive urinary sediment, renal biospy was done. Biopsy was suggestive of MPGN with faint IgM and C3 deposits. He was started on urgent dialysis for elevated creatinine and steroids initiated.
Peritoneal fluid creatinine was reported high consistent with urine leak in the peritoneum.CT Cystogram confirmed urinary leak. He was emergently taken up by urology for cystorraphy.

Discussion

This case highlights phenomenon of bladder rupture, urinary ascites and pseudo-renal failure. Bladder rupture can occur following trauma, irradiation, iatrogenic or spontaneous. Pseudo renal failure is the elevation of the creatinine from the resorption of the peritoneal fluid from urinary leak. If the ascitic fluid creatinine is significantly higher than serum levels, one should consider spontaneous bladder perforation as the etiology for the urinary ascites. CT cystogram is the gold standard imaging technique for diagnosis.