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      Pseudo‐acute kidney injury after minor trauma: A case report and review of literature


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          Acute kidney injury (AKI), a common diagnosis in the emergency department, is defined as a reduction in renal filtration function, with decrease in urine output, increase in serum creatinine, or both. However, a rise in serum creatinine can occur without AKI: the principal cause of a pseudo‐AKI is urinary ascites, caused by urinary tract rupture, followed by reverse intraperitoneal dialysis and resorption of creatinine. The intraperitoneal leak of free urine is mainly traumatic, and half of the cases are iatrogenic. A case of intraperitoneal bladder rupture after minor trauma is presented with a review of the pathology of pseudo‐AKI.

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          Most cited references13

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          Consensus statement on bladder injuries.

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            False estimates of elevated creatinine.

            One of the most common reasons for a nephrology consult is an elevated creatinine. An elevation in the serum creatinine concentration usually reflects a reduction in the glomerular filtration rate (GFR). Given the association of elevated creatinine and risk of cardiovascular mortality, it is important to keep in mind that at times the elevation of the creatinine is not representative of a true reduction in GFR. There are various causes of factitious elevation of creatinine. They can be broadly grouped into increased production of creatinine, interference with the assay and decreased tubular secretion of creatinine.
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              Delayed diagnosis of spontaneous bladder rupture: a rare case report

              Background Bladder rupture caused by trauma or pelvic fracture is very common, and can be easily diagnosed. However, Spontaneous rupture of the bladder is rare. Reported by Peters PC. (Peters, Urol Clin N Am 16:279–82, 1989): The incidence of spontaneous bladder rupture is 1: 126000. During childbirth, the occurrence rate of this disease is lower than that of the former. It is very difficult to make an early diagnosis of the spontaneous rupture of the bladder during childbirth, which eventually results in high maternal mortality. Due to peritoneal reabsorption, the patient may show high levels of serum creatinine and potassium, and this would easily be misdiagnosed as acute renal failure. However, these patients have normal renal function, hence the diagnosis of renal failure is incorrect. Case presentation A 23 year-old female patient had her first pregnancy and delivered a full-term healthy baby girl. After delivery, the patient developed fever, oliguria, massive ascites, high serum creatinine and high serum potassium. The patient was initially diagnosed with acute renal failure, however treatment for her condition was ineffective. After further examination, the patient was diagnosed with intraperitoneal bladder rupture. The patient was treated for bladder rupture, made a full recovery and was discharged. Conclusions Sudden onset of massive ascites and renal failure due to abnormal serum biochemical characteristics after delivery should be first diagnosed as spontaneous bladder rupture. However, bladder radiography may suggest a false negative result, hence cystoscopy should be performed to confirm the diagnosis. The ratio between ascites creatinine and serum creatinine would be helpful for early diagnosis and to determine the time of rupture. Conservative management or surgical repair should be used to treat bladder rupture.

                Author and article information

                J Am Coll Emerg Physicians Open
                J Am Coll Emerg Physicians Open
                Journal of the American College of Emergency Physicians Open
                John Wiley and Sons Inc. (Hoboken )
                13 October 2021
                October 2021
                : 2
                : 5 ( doiID: 10.1002/emp2.v2.5 )
                [ 1 ] Department of Emergency Medicine Epicura Centre Hospitalier Brussels Belgium
                [ 2 ] Department of Internal Medicine Epicura Centre Hospitalier Brussels Belgium
                [ 3 ] Department of Nephrology Epicura Centre Hospitalier Brussels Belgium
                [ 4 ] Department of Cardiology Epicura Centre Hospitalier Brussels Belgium
                Author notes
                [*] [* ] Correspondence

                Diana Cheung, MD,Department of Emergency Medicine, Epicura Centre Hospitalier, B7301 Hornu (Boussu), Belgium.

                Email: drcheungdiana@ 123456gmail.com

                © 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Figures: 1, Tables: 1, Pages: 4, Words: 2309
                Case Report
                Custom metadata
                October 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.8 mode:remove_FC converted:13.10.2021

                acute kidney injury,bladder injury,emergency department,pseudo‐acute kidney injury,reverse autodialysis,urinary ascites


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