Hypercreatininemia and hyperglycemia: diabetic nephropathy or "inverted peritoneal auto-dialysis"?
We describe a case of 51-year-old male with fever, abdominal pain and inguino-scrotal hernia. Laboratory examination revealed hypercreatininemia and hyperglycemia, firstly interpreted as diabetic nephropathy. US and CT scan showed a hernia of the bladder into the scrotum. Surgery revealed multiple bladder perforations with peritoneal diffusion of urine. So, hypercreatininemia was caused by peritoneal reabsorption of urea and creatinine, a condition that may be described as "inverted peritoneal auto-dialysis". Surgical reposition and repairment of the bladder led to rapid normalization of serum urea and creatinine. Discharged diagnosis was intraperitoneal rupture of inguino-scrotal hernia of the bladder in patient with recent onset of diabetes mellitus.
Manna
R
R
Department of Internal Medicine, Catholic University, Rome, Italy. rmanna@rm.unicatt.it
Mirk
P
P
Sallustio
G
G
Brisinda
G
G
Izzi
D
D
La Regina
M
M
Nucera
G
G
Maria
G
G
Montalto
M
M
Ghirlanda
G
G
D003404:Creatinine / Q000097:blood*; D003928:Diabetic Nephropathies / Q000175:diagnosis*; D003951:Diagnostic Errors; D006552:Hernia, Inguinal / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000150:complications; D001745:Urinary Bladder Diseases / Q000150:complications / Q000175:diagnosis*
D003404:Creatinine