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Kidney Week

Abstract: PO0319

Pseudo AKI: When the Kidney Biopsy Doesn't Match the Creatinine

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Waktola, Abebech J., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Burgner, Anna Marie, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction

Elevated Creatinine (Cr) without AKI can be seen due to increased production of Cr, interference with the assay, decreased tubular secretion of Cr and urine ascites. We report a patient who presented with pseudo AKI due to delayed urine leak after prostatectomy.

Case Description

A 53-year-old male with PMH of hypertension, mixed connective tissue disease and prostate cancer was admitted to an outside hospital 6 weeks after prostatectomy due to AKI noted during post op follow up visit. He had abdominal pain for which he was taking naproxen, nausea and oliguria. Labs showed a Cr 6.58 mg/dl (baseline 1.1 mg/dl), proteinuria, hematuria and pyuria. A CT of his abdomen showed fluid in his pelvis and no hydronephrosis. His Cr worsened despite supportive care. Serologic testing was unremarkable and a renal biopsy revealed mild acute tubular injury and glomerulomegaly. His Cr improved to 5 mg/dl with foley catheter placement and he was discharged. He presented to our ED two days later with worsening symptoms. Labs revealed his Cr had worsened to 10.8mg/dl and BUN was 103 mg/dl. He had hyperkalemia, metabolic acidosis, hyponatremia and hyperphosphatemia. A repeat CT of his abdomen revealed fluid in the retropubic space and free fluid in peritoneum concerning for an anastomotic leak. Static cystogram confirmed a leakage from the vesicourethral anastomotic site into the retropubic space. A drain was placed in retropubic space and a foley catheter was maintained. He was discharge with resolution of symptoms, drain and foley catheter in place with Cr of 1.1mg/dl and normal electrolytes.

Discussion

Vesicourethral anastomotic urinary leak is reported in 8.6-13.6% of cases after laparoscopic prostatectomy and most cases present within 8 days after surgery. Patients usually present with symptoms due to urine leak resulting in peritonitis, paralytic ileus and pseudo AKI.
Pseudo AKI is a rare condition with biochemical evidence of AKI in the absence of structural kidney damage or injury. It can be seen following genitourinary surgery, blunt abdominal injury or radiation therapy leading to urine ascites. Urine ascites causes reverse auto peritoneal dialysis characterized by flux of small molecules from collected peritoneal urine to blood.
Nephrologists should have a high degree of suspicion for pseudo AKI in patients who present with oliguria, ascites and biochemical evidence of AKI following genitourinary surgery.