Abstract: SA-PO234
Bilateral Resection of Renal Cell Carcinoma with Postoperative Urinary Ascites
Session Information
- Onconephrology: Immunological Cross-Talk
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Baker, Matthew Foster, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Watson, Maura A., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Introduction
Urinary ascites is a rare complication of nephrectomy in the absence of bladder or ureteral injury.
Case Description
A man in his fifties with bilateral renal cell carcinomas underwent left total nephrectomy and right partial nephrectomy. He was treated with neo-adjuvant and adjuvant nivolumab. His pre-operative creatinine was 1.0 mg/dL. Two weeks post nephrectomies, he was hospitalized for anuric acute kidney injury. Urine microscopy revealed acute tubular necrosis (ATN). He had large-volume ascites, despite normal hepatic function, which was consistent with urine based on drained ascitic fluid creatinine level of 78.9 mg/dL. Serum creatinine peaked at 12.65 mg/dL and improved to 2.2 mg/dL after paracentesis and right ureteral stenting. Creatinine decreased to 1.9 mg/dL at discharge. He was readmitted two months later for Enterococcus faecalis bacteremia. CT IV pyelogram demonstrated active extravasation of contrast from the right renal pelvis and formation of a right perinephric urinoma which was 5.1 cm wide. Serum creatinine increased from 2.2 mg/dL on admission to 3.25 mg/dL by the time of hospital discharge. Follow-up imaging one month later demonstrated decrease in size of the right perinephric urinoma but with persistent extravasation of contrast from the right renal collecting system. Four months after right ureteral stent placement, the stent was removed and intraoperative retrograde pyeloureterogram showed no renal collecting system extravasation. His serum creatinine eventually settled at 1.9 mg/dL with a stable estimated glomerular filtration rate of 49 mL/min.
Discussion
Urinary ascites directly from the renal collecting system, as shown on imaging in this case demonstrates an unusual complication of bilateral nephrectomies. Loss of nephron mass, bacteremia, and post-operative ATN contributed to chronic kidney disease development, but estimation of renal function was likely clouded by reabsorption of creatinine from extravasated urine. The urinoma eventually became walled off and collecting system defects in the remaining kidney healed. Urinary leak leading to large volume ascites may occur post nephrectomy and should be considered in patients without hepatic injury.
The views expressed in this abstract are those of the author(s) and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government.