Abstract: SA-PO1192
Delayed Urinary Ascites After Kidney Transplantation: Two Cases of Pseudo-AKI Mimicking Allograft Disease
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Dodin, Omar, University of Illinois Chicago, Chicago, Illinois, United States
- Hajjiri, Zahraa, University of Illinois Chicago, Chicago, Illinois, United States
- Naik, Ruchi Harshadrai, University of Illinois Chicago, Chicago, Illinois, United States
- Miqdad, Mohammed A., University of Illinois Chicago, Chicago, Illinois, United States
Introduction
Delayed urine leak after kidney transplantation can mimic intrinsic allograft dysfunction. Urinary ascites may cause pseudo-AKI through reverse peritoneal dialysis.
Case Description
Case 1 was a 60-year-old man with ESRD from hypertension/secondary FSGS, s/p LRKT in 9/2022, baseline creatinine ~0.8-1.0 mg/dL. More than 3 years later, after cystoscopy for recurrent dysuria/urinary retention, he presented with abdominal pain, emesis, distension, urinary retention, oliguria, and severe AKI. Creatinine rose to 9.19 mg/dL and UPCR to 15.7 g/g, prompting concern for rejection, RPGN, or de novo GN. Biopsy was deferred when ascites was identified. Ascitic fluid creatinine was 13.16 mg/dL, 17.15 mg/dL on repeat, exceeding serum creatinine. Cystourethrogram showed an intraperitoneal bladder dome defect with contrast extravasation. He underwent cystoscopy, transplant ureteral stenting, and robotic bladder repair. Operative findings included 8 L intra-abdominal urine, high-capacity trabeculated bladder, and bladder dome fistula near the ureteroneocystostomy with thin adjacent bladder wall. Within 48 hours, creatinine improved to 0.88 mg/dL and UPCR to 1.09 g/g.
Case 2 was a 59-year-old SPK recipient transplanted in 11/2020 who presented >2 years later with abdominal distension, ascites, and AKI. Creatinine rose from 1.86 to 7.42 mg/dL. Ascitic fluid creatinine was 20.05 mg/dL and later 14.76 mg/dL. CT urogram showed subtle extraluminal contrast near the ureterovesical anastomosis, suspicious for urine leak. Likely etiology was acute-on-chronic urinary obstruction from BPH with Foley dependence; traumatic Foley insertion was also considered. He improved with Foley decompression/supportive care and later underwent thulium laser enucleation of the prostate. Subsequent cystogram ruled out persistent bladder leak; repeat paracentesis showed fluid creatinine 0.99 mg/dL.
Discussion
Delayed urinary leak can present years after transplant with ascites, oliguria/retention, severe AKI, and pseudo-proteinuria, mimicking rejection or de novo glomerular disease. Ascitic fluid creatinine exceeding serum creatinine is a rapid clue for uroperitoneum. Reverse peritoneal dialysis can reabsorb urinary solutes despite preserved graft function. This diagnosis should remain on the differential with urinary retention, obstruction, traumatic catheterization, or instrumentation.