Nephrogenic Ascites: An Unusual Culprit of Refractory Ascites in a Hemodialysis Patient-A Case Report and Review of Literature

Abstract

Nephrogenic ascites or dialysis-associated ascites is a rare condition that develops in patients with end-stage renal disease (ESRD) who have been on long-term hemodialysis. It is characterized by rapidly accumulating ascites that is often recurrent and resistant to standard treatment. The diagnosis typically requires the exclusion of common causes of ascites including possible hepatic, cardiac, malignant, and infectious etiologies. Nephrogenic ascites generally has a poor prognosis. Renal transplantation is the sole definitive cure for this difficult-to-treat clinical entity, however, majority of the affected patients are usually deemed unsuitable candidates for transplantation. In this communication, the authors presented a rare case of nephrogenic ascites that posed a therapeutic challenge in an ESRD patient on regular hemodialysis along with a brief review of the literature regarding the pathogenesis, clinical features, and outcome of nephrogenic ascites.

Keywords: dialysis-associated ascites; end-stage renal disease; hemodialysis; nephrogenic ascites; renal transplantation.

Figure 1. Axial image of contrast-enhanced CT abdomen with massive ascites (horizontal red arrow).