Rex Tzu-Yu Lai, Thomas Tao-Min Huang

The concurrent presentation of oliguria, massive ascites, and severe azotemia typically suggests true acute kidney injury (AKI), such as hepatorenal syndrome. However, this clinical picture can be mimicked by the rare condition of pseudo-AKI. We report a 42-year-old woman with CKD stage 3 and prior subtotal hysterectomy who presented with progressive oliguria, abdominal distension, weight gain, and a serum creatinine of 6.4 mg/dL. An initially high serum–ascites albumin gradient (SAAG) misleadingly pointed toward portal hypertension despite no clinical evidence of liver disease. Contrast-enhanced pelvic MRI demonstrated small-volume pelvic ascites with suspected contrast extravasation adjacent to the bladder, consistent with urinary leakage, and a following ascitic fluid analysis confirmed urinary ascites with an ascitic fluid-to-serum creatinine ratio of 6.4. Azotemia resolved completely with conservative management via continuous bladder drainage. This case underscores the importance of considering urinary ascites in the differential diagnosis of AKI with ascites and past pelvic surgery, while also highlighting the diagnostic value of ascitic fluid analysis, especially when imaging studies are inconclusive.

賴子聿，黃道民

臨床上病患若同時出現少尿、大量腹水及嚴重氮血症，常直覺聯想到急性腎損傷 (acute kidneyinjury, AKI)，如肝腎症候群。然而，這類表現亦可能由罕見之偽急性腎損傷所致。本報告呈現一例自發性膀胱破裂導致之尿液性腹水，造成偽急性腎損傷之個案，並探討其診斷思維與治療重點。本例為一名42 歲女性，具慢性腎臟病第三期及子宮次全切除術病史，因持續進展之寡尿、腹脹與體重增加就診，入院時血清肌酸酐升至6.4 mg/dL。初步腹水分析顯示血清-腹水白蛋白梯度(SAAG)偏高，指向門脈高壓，然臨床上並無肝病證據。骨盆腔增強 MRI 顯示骨盆腔少量腹水，膀胱鄰近可見對比劑外滲，與尿液滲漏相符，結合後續腹水與血清分析顯示腹水肌酸酐 / 血清肌酸酐比值高達 6.4，而確診為尿液性腹水。推測病因為先前婦科手術導致之膀胱壁弱點，發生自發性破裂。經持續膀胱引流治療後，腎功能完全恢復，無需進一步侵入性處置。此病例提示，對於有骨盆腔手術史且出現腹水與 AKI 之病患，應將尿液性腹水列入鑑別診斷。腹水肌酸酐與血清肌酸酐比值 >1.0 為簡便且具鑑別力之檢驗，應於第一時間施行以避免不必要處置。