Intraperitoneal bladder rupture mimicking acute renal failure

Abstract

We describe a patient who presented with acute onset of abdominal pain, oliguria, gross hematuria and uremia. Further examination revealed spontaneous intraperitoneal rupture of the urinary bladder. Upon repair of the rupture, his biochemistry normalized within 24 h. Acute renal failure is characterized by an abrupt decline in glomerular filtration rate (GFR), biochemically reflected by elevation in serum creatinine level. It usually displays multifactorial etiology and can be classified as prerenal, renal and postrenal. In this case report, we describe a situation in which the increase in serum creatinine level was not related to any of these factors and was associated with normal GFR and absorption of urine across the peritoneal membrane following spontaneous rupture of bladder.

Uroperitoneum as a Complication of Laparoscopic Cholecystectomy: A Case Report

“…Urine consists of a higher level of creatinine and nitrogen waste products as compared with serum [15]. As a result, the peritoneum serves as a semipermeable membrane allowing concentration gradient diffusion while urine is in contact with the peritoneum, a condition termed reversed auto-dialysis [16]. As demonstrated in our case, the serum creatinine level rises while the glomerular filtration rate of the patient is practically stable [15].…”

Postoperative intraperitoneal bladder rupture detected by renal scintigraphy: The importance of postvoid imaging

“…[ 4 ] The elevation of serum creatinine is secondary to the absorption of urine across the peritoneal membrane and is a known mimicker of presentations of acute renal failure. [ 5 6 ] A CT examination is the most common tool in the diagnosis of bladder rupture. [ 7 ] Renal scintigraphy is not the first-line imaging modality in the diagnosis of bladder rupture; however, with unexplained laboratory values and symptoms within a postoperative patient, renal scintigraphy can play a pivotal role; postvoid and delayed phase imaging, in particular, can demonstrate sequela of a bladder rupture as well as other sequela of postsurgical complications with damage to the collecting system.…”

Pseudorenal Failure Secondary to Reversed Intraperitoneal Autodialysis

“…Because the bladder has both an intraperitoneal and an extraperitoneal component, urine can extravasate in both compartments, generating different symptoms. Extraperitoneal perforation is most often associated with blunt trauma, presenting as suprapubic pain, edema, and oliguria [ 1 – 3 ]. This case reports a young man with an iatrogenic tear in the intraperitoneal component of the bladder, generating progressive urinary ascites.…”

“…Stasis of urine in the peritoneal cavity allows for reversed intraperitoneal autodialysis to take place. The higher concentration of creatinine and nitrogenous waste products in the urine as compared to plasma allows for concentration gradient diffusion when the urine is in contact with the peritoneum, functioning as a semipermeable membrane [ 1 , 3 , 4 ]. As illustrated in this case, the patient's serum creatinine will rise.…”