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Kidney Week

Abstract: TH-PO133

Stage 3 AKI, Rhabdomyolysis, and Hyponatremia Developing Within 48 Hours of Transurethral Resection of Bladder Tumor (TURBT)

Session Information

  • AKI: Mechanisms - I
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Fichadiya, Harshil, Monmouth Medical Center, Long Branch, New Jersey, United States
  • Bhide, Poorva P., Monmouth Medical Center, Long Branch, New Jersey, United States
  • Fichadiya, Hardik, Trinitas Regional Medical Center, Elizabeth, New Jersey, United States
  • Tiperneni, Raghu, Monmouth Medical Center, Long Branch, New Jersey, United States
  • Heis, Farah, Monmouth Medical Center, Long Branch, New Jersey, United States
  • Al-Alwan, Ahmad S., Monmouth Medical Center, Long Branch, New Jersey, United States
Introduction

1/3 AKI associated with urologic procedures are seen following elective procedures while 2/3 are seen in patients admitted from the emergency department with the need of a urological intervention. Among elective procedures nephrectomy is the most common etiology of AKI, while sepsis and urinary obstruction are major culprits of AKI for patients requiring emergent urological intervention. TURBT is rarely associated with AKI with most reported cases from pre-renal and post-renal etiology.

Case Description

62 year old male developed sudden onset renal failure with 8 fold rise in serum creatine within 48 hour of TURBT procedure that was complicated by extra-peritoneal rupture of bladder. Euvolemic moderate hyponatremia and mild rhabdomyolysis were seen. His bladder injury was managed conservatively with foley catheter and regular monitoring of urine output. His serum creatinine urine output started to improve on post op day 5 and hyponatremia improved with fluid restriction.

Discussion

The following mechansims lead to development of AKI in our patient:
1) Extraperitoneal rupture of bladder causing leak and systemic absorption of irrigating fluid from systemic veins-> free fluid excess in plasma-> hyponatremia-> muscle swelling and rupture-> rhabdomyolysis-> ATN
2) Reflux of heme and saline from the bladder to renal tubules via the renal collecting system-> toxic damage to renal tubules ->ATN
3) Hemodynamic changes during TURBT procedure cause decreased renal blood flow->pre-renal injury and tubular damage->AKI
We recommend restricting the use of irrigating fluid, avoiding hemodynamic changes, careful post-operative monitoring of renal function, electrolytes, CPK post TURBT, and ruling out obstructive etiology with renal imaging.