Abstract: TH-PO0721
When the Alfa Backfires: A Case of Alfapump-Associated Kidney Injury and Proteinuria
Session Information
- AKI: Prevention, Diagnostics, and Management
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Sanchez Trinidad, Jeanette Marie, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Mc Daid, Alexander Andrew, Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Ohonba, Nosagie, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- He, John Cijiang, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Introduction
The automated low-flow ascites pump (“alfapump”) is a battery powered pump that is implanted subcutaneously in the abdominal wall and connected to catheters in the peritoneal cavity and the urinary bladder, allowing continuous removal of ascitic fluid via urination. It is used to treat refractory ascites in patients with contraindications to recurrent LVPs, TIPS or liver transplant. We present a case of AKI and nephrotic-range proteinuria following alfapump implantation.
Case Description
A 65-year-old female with metastatic breast carcinoma with liver involvement, complicated by refractory ascites s/p alfapump placement 1-week prior admission, presented with shortness of breath and nausea. Admission creatinine was 1.9mg/dL increased from baseline of 0.8mg/dL. Urinalysis showed hematuria and proteinuria, with urine protein-to-creatinine ratio (UPCR) of 18g/g and urine albumin-to-creatinine ratio (UACR) unable to be calculated, raising concern for nephrotic syndrome.
Extensive serologic evaluation for nephrotic syndrome was unrevealing. The patient was treated with 25% albumin, 25g twice daily, resulting in improvement in creatinine to 0.7mg/dL and UPCR of 9g/g. She was discharged with outpatient nephrology follow up for continued monitoring of proteinuria.
Discussion
Renal dysfunction is one of the most common adverse effects associated with alfapumps. Approximately 30% of patients develop an AKI and creatinine increased by approximately 0.26mg/dL in patients 1 week after alfapump implantation, and eGFR has been reported decrease average of 20ml/minute/1.73m^2 at 6 months post implantation. The exact mechanism remains unclear. In the immediate post implantation period, renal dysfunction is thought to be affected by changes in intra-abdominal pressure, systemic inflammation and hemodynamic changes, mimicking post paracentesis circulatory syndrome. Proteinuria has also been reported, however, interpretation requires caution, as urinary protein may reflect protein from ascitic fluid rather than glomerular disease. AKI associated with alfapumo often responds to albumin administration and prophylactic albumin supplementation during first month post implantation has been recommended.