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Kidney Week

Abstract: FR-PO225

Pseudo-Renal Failure After Laparoscopic Hernia Repair

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Vaghari Mehr, Nazanin, Yale School of Medicine, New Haven, Connecticut, United States
  • Crowley, Susan T., Yale School of Medicine, New Haven, Connecticut, United States
Introduction

Bladder wall rupture cause high mortality if not diagnosed urgently. It can lead to extravasation of urine in peritoneum followed by anuria, abdominal pain, rise in serum Creatinine and be misdiagnosed as acute renal failure. We report a rare case of pseudo-renal failure in the setting of bladder wall rupture following laparoscopic repair of umbilical and bilateral inguinal hernia.

Case Description

50 year old man with seizure disorder presented for laparoscopic repair of bilateral inguinal hernia and umbilical hernia. He was admitted for observation due to self limited seizure. Labs showed rise in creatinine of 2.4 mg/ dL. Patient developed urinary retention and required straight catheterization. Serosanguis drainage from lower surgical port site developed. His abdominal pain increased significantly and Creatinine continued to rise to 3.4 mg/dL. Nephrology was consulted for presumed acute renal failure. Patient had continued urinary retention with minimal improvement with foley placement on POD 3. Surgical port site drainage Urea and Cr were 81 and 14.2 mg/dL respectively. A CT cystogram showed bladder wall rupture and fluid extravasation to pre-peritoneal space. Serum Creatinine returned to baseline (0.9 mg/dL) immediately post bladder wall repair.

Discussion

Bladder rupture and urinary ascites can cause pseudo-renal failure in presence of normal renal function. Urinary ascites alters concentration gradient of peritoneal fluid and serum resulting in rapid increase of serum urea and creatinine while maintaining normal GFR. We suggest pseudo-renal failure consideration when suspecting urinary ascites as well as using peritoneal urea and creatinine to help diagnosis. Urgent Cystoureterogaphy is key for bladder rupture diagnosis and urgent bladder repair along with foley placement to relieve obstruction is essential to avoid further complications and rapid return of labs to baseline.