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Kidney Week

Abstract: PO0905

An Unexpected Cause of Colitis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bnaya, Alon, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
  • Benjaminov, Ofer, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
  • Itzkowitz, Eyal, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
  • Atrash, Jawad, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
  • Abu Lybdeh, Omar, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
  • Abu Alfeilat, Mohsen, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
  • Shavit, Linda, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
Introduction

Gastrointestinal manifestations are common among patients with advanced kidney disease. However, uremia associated colitis is rarely described in patients with ESKD. We present a unique case of uremic pancolitis in a patient with ESKD of unknown cause.

Case Description

An 18-year-old male with a history of asthma was admitted with nausea, vomiting and diffuse abdominal pain. He had no fever, arthralgias, rash, respiratory symptoms, or diarrhea. Mild peripheral edema and flapping tremors were noted on physical examination. Laboratory blood tests revealed severe kidney injury (creatinine 18.2 mg/dL, BUN 129 mg/dL). Urinalysis was positive for blood and protein. Immunologic and infectious serologies were unremarkable. An abdominal CT scan detected two small atrophic kidneys and diffuse severe bowel wall thickening of the colon with thumb printing noted (Figure 1), mimicking a pseudomembranous colitis pattern. Abdominal ultrasound revealed severe edema along with high vascularization of the colon wall.
Uremia associated colitis was suspected due to the patient’s extreme uremic state and hemodialysis was initiated. Following three weeks of hemodialysis, an abdominal ultrasound showed a significant improvement in edema and vascularization of the colon wall.

Discussion

Patients with advanced CKD often have a variety of gastrointestinal symptoms. However, severe uremic colitis mimicking pseudomembranous pattern is extremely rare in ESKD. Extensive literature review revealed only single case report of uremic pancolitis in a patient with severe kidney injury related to IgA nephropathy.
With the improvement of care of patients with kidney disease, uremic colitis is rarely seen in the routine nephrology practice. However, it should be included in the differential diagnosis and evaluation of patient with ESKD, particularly if other more frequent etiologies of colitis have been excluded.