Kidney Week

Abstract: TH-PO0425

Resolution of Hyperchloremic Metabolic Acidosis in a Neobladder Patient Following Percutaneous Nephrostomy Tube Placement: A Novel Nephrology Intervention

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Dildar, Jalal, Richmond University Medical Center, New York, New York, United States

Jalal Dildar, MD

• Kiroycheva, Militza K., Richmond University Medical Center, New York, New York, United States

Militza K. Kiroycheva, MD

• Dalezman, Solomon, Richmond University Medical Center, New York, New York, United States

Solomon Dalezman, MD

• Baig, Mohammad Ashar, Richmond University Medical Center, New York, New York, United States

Mohammad Ashar Baig

• Way, Joi A, Richmond University Medical Center, New York, New York, United States

Joi A Way

• Hashmi, Razi Haider, Richmond University Medical Center, New York, New York, United States

Razi Haider Hashmi, MD

• Hashmat, Ahmad Jamal, Richmond University Medical Center, New York, New York, United States

Ahmad Jamal Hashmat, MD

Introduction

Neobladders created from ileal segments post-cystectomy can lead to significant metabolic disturbances. The intestinal mucosa continues reabsorbing chloride in exchange for bicarbonate, contributing to hyperchloremic non-anion gap metabolic acidosis (NAGMA). In addition, urinary stasis and colonization with urease-positive organisms may further raise urinary pH, exacerbating systemic acidosis. Some patients develop a clinical picture resembling distal renal tubular acidosis (RTA), with impaired distal hydrogen secretion and high urine pH. We present a case where bilateral percutaneous nephrostomy (PCN) tubes led to resolution of these disturbances.

Case Description

A 77-year-old woman with a history of bladder cancer status post-cystectomy with ileal neobladder presented with altered mental status. Imaging showed neobladder distension, bilateral hydroureteronephrosis, and UTI. Labs showed NAGMA (Na: 137, Cl: 111 mmol/L, CO₂: 16 mmol/L), hypokalemia (K: 3.0 mmol/L), and high urine pH of 8, consistent with distal RTA physiology. A 12F suprapubic catheter was placed, but recurrent UTIs and electrolyte abnormalities persisted. On 01/24/25, bilateral PCNs were placed. Following this, potassium normalized to 4.1 mmol/L, chloride decreased to 107 mmol/L, and acidosis resolved dramatically.

Discussion

Hyperchloremic metabolic acidosis in neobladder patients stems from intestinal chloride reabsorption and bicarbonate loss. In this case, the high urine pH and electrolyte profile resembled distal RTA, possibly exacerbated by infection with urease-producing bacteria. PCNs likely reduced urinary stasis and contact time with the ileal mucosa, decreasing acid reabsorption and infection burden. This case suggests PCNs may have a nephrology role in correcting refractory electrolyte imbalances in neobladder patients. Further investigation is warranted.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025shan3e8n