Nephrogenic Ascites HD — ESENeph MCQ

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HardHaemodialysisNephrogenic Ascites HDESENeph

A 65-year-old man with CKD G5D on haemodialysis develops new-onset ascites. He has no liver disease or heart failure. PD has never been performed. Peritoneal fluid is transudative. What renal-related cause should be considered?

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Correct answer: B — Nephrogenic ascites (uraemic serositis)

Nephrogenic ascites (also called dialysis-related or uraemic ascites) is an uncommon complication in long-term haemodialysis patients without liver disease or heart failure. The pathogenesis involves uraemic peritoneal inflammation and fluid shifts related to volume overload and hypoalbuminaemia. The fluid is typically transudative. Treatment includes intensified dialysis (longer or more frequent sessions), peritoneal drainage, and in some cases, switching to peritoneal dialysis (which can paradoxically improve the ascites). Kidney transplantation is definitive.

Reference: Gluck and Nolph 1987 – Nephrogenic Ascites; ERA-EDTA – Dialysis Complications