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abdominal compartment syndrome

Etiology: - volume overload - massive ascites - intra-abdominal hemorrhage - abdominal surgery [1] Pathology: - intra-abdominal or intravesicular (bladder) pressure > 20 mm Hg - new-onset organ system failure, including oliguric acute renal failure from renal artery vasocontriction &/or renal vein compression [1] Laboratory: - urine sodium may be low - fractional excretion of sodium may be > 1% due to renal injury despite prerenal origin in increased abdominal pressure Special laboratory: - bladder catheterization to measure intravesicular pressure [1] Management: - surgical (laparoscopic) decompression of the abdomen may improve renal function - large volume paracentesis if due to massive ascites [5]

General

compartment syndrome postrenal azotemia; obstructive uropathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2013, 2015, 2018, 2021.
  2. De Waele JJ, De Laet I, Kirkpatrick AW, Hoste E. Intra-abdominal Hypertension and Abdominal Compartment Syndrome. Am J Kidney Dis. 2011 Jan;57(1):159-69. PMID: 21184922
  3. Mohmand H, Goldfarb S. Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome. J Am Soc Nephrol. 2011 Apr;22(4):615-21. Review. PMID: 21310818 Free Article
  4. Patel DM, Connor MJ Jr. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: An Underappreciated Cause of Acute Kidney Injury. Adv Chronic Kidney Dis. 2016 May;23(3):160-6. Review. PMID: 27113692
  5. NEJM Knowledge+ Nephrology/Urology