Abstract: PUB113
Recurrent Bilateral Pleural Effusion Secondary to Urinothorax in a Patient with Obstructive Uropathy and ESRD
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Khalique, Sumon, HCA Healthcare Inc, Kingwood, Texas, United States
- Parikh, Aarohi, HCA Healthcare Inc, Kingwood, Texas, United States
Introduction
Urinothorax is a rare cause of pleural effusion caused by urine accumulation within the pleural cavity, most commonly associated with obstructive uropathy or recent urologic instrumentation. Diagnosis is challenging because symptoms often mimic more common cardiopulmonary diseases. Pleural fluid-to-serum creatinine ratio greater than 1 is considered diagnostic.
Case Description
An 87-year-old male with end-stage renal disease on maintenance hemodialysis, recurrent nephrolithiasis with bilateral ureteral stents, coronary artery disease, congestive heart failure, hypertension, and hyperlipidemia presented with acute left flank pain after dialysis. On admission, he was septic with tachycardia, tachypnea, leukocytosis, elevated lactic acid, and urinalysis concerning for urinary tract infection. CT abdomen/pelvis demonstrated bilateral nephrolithiasis, chronic obstructive uropathy, and bilateral ureteral stents. He was diagnosed with complicated pyelonephritis.
During hospitalization, he developed progressive hypoxic respiratory failure with recurrent bilateral pleural effusions and left hydropneumothorax requiring thoracenteses, chest tube placement, and pigtail drainage. Pleural fluid analysis demonstrated a transudative effusion with pleural fluid-to-serum creatinine ratio >1, highly suggestive of urinothorax. Hypercapnic respiratory failure required BiPAP support.
The patient underwent multidisciplinary management with antibiotics, optimization of hemodialysis, pleural drainage, and planned ureteral stent exchange. Following treatment of the obstructive urinary pathology, respiratory status improved significantly with removal of the pigtail catheter and discontinuation of oxygen.
Discussion
Urinothorax should be considered in patients with recurrent unexplained pleural effusions in the setting of ESRD, obstructive uropathy, nephrolithiasis, or recent urologic intervention. Early diagnosis and treatment are critical to prevent recurrent respiratory complications.
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