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Kidney Week

Abstract: FR-PO197

Ascites and Bilateral Hydronephrosis

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Remillard, Brian D., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Kaur, Ramandeep, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Dickinson, Micaela M., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Block, Clay A., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Hoffer, Eric K., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
Introduction

Tense ascites resulting in bilateral hydronephrosis documented by antegrade nephrostograms before and after large-volume paracentesis (LVP).

Case Description

A 63-year-old man presented with cirrhosis presented with ascites, confusion and oliguria. Initial laboratory evaluation revealed elevated blood urea nitrogen 91 mg/dL and creatinine 5.97 mg/dL. Three months earlier, these were 7 mg/dL and 0.97 mg/dL, respectively. Ultrasound showed massive ascites and bilateral grade 2 hydronephrosis. A urinary catheter yielded 100 mL of urine. Computed Tomography confirmed bilateral hydronephrosis. It was hypothesized that massive ascites was the cause of the hydronephrosis. Antegrade nephrostogram found absent flow and fixed narrowing at the pelvic brim. The initial left renal pelvis pressure measured 15 mmHg. After LVP of 5 liter, renal pelvis pressure was 0 mmHg and fluoroscopy demonstrated ureteral peristalsis with antegrade flow into the bladder with resolution of the narrowed segment. Retroperitoneal ultrasound four days later confirmed resolution of hydronephrosis.

Discussion

Resolution of the elevated collecting system pressure and outflow obstruction after paracentesis supported tense ascites as the etiology for the acute kidney injury.

Pre-paracentesis

Post-paracentesis