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Cadoret F, Brazet E, Sartor A, Lacroix I, Casper C, Decramer S, Parant O. Unusual fetal ascites and spontaneous bladder rupture in a female fetus: a case report. J Med Case Rep 2020; 14:115. [PMID: 32684161 PMCID: PMC7370489 DOI: 10.1186/s13256-020-02425-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal bladder rupture causing urinary ascites is uncommon. It is generally related to invasive fetal medicine procedures or obstructive disorders such as in posterior urethral valves in male fetuses. An exceptional case of spontaneous bladder rupture in a female fetus occurred in a pregnant woman treated with high doses of opiates in an intensive care unit. This unusual obstetric situation leads to discussion of the possible causes of fetal bladder rupture, its management, and the pediatric prognosis. CASE PRESENTATION We report the case of a 30-year-old nulliparous black woman with a history of mesenteric cystic lymphangioma and multiple bowel resections leading to chronic malabsorption. During her pregnancy, our patient presented with an occlusive syndrome and major bilateral renal dilation. Urinary derivation resulted in iatrogenic bilateral ureteral perforation. Our patient thus presented with major uroperitoneum, bilateral pleural effusion and acute renal failure, treated by thoracic drainage and bilateral nephrostomy. Postoperative pain required treatment with level III analgesics. In this context, 5 days after morphine treatment introduction an enlarged fetal bladder was observed, followed 3 days later by voluminous fetal ascites. The diagnosis of spontaneous bladder rupture was suspected. After multidisciplinary discussion, expectant management was decided. At 31 weeks and 4 days gestation, our patient went into spontaneous labor with a subsequent vaginal delivery. The infant required resuscitation and paracentesis of ascites at birth. Her neonatal course was favorable with a simple urethral bladder drainage. Cystography at day 9 was normal. At 2 years of follow-up, the mother and the child have a normal course. CONCLUSIONS An iatrogenic origin of megacystis in a female fetus must be evoked in the event of maternal administration of high doses of opiates in the second part of her pregnancy. In our case, the megacystis was followed by spontaneous bladder rupture at 30 weeks of gestation, with a favorable maternal fetal issue.
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Affiliation(s)
- Florence Cadoret
- CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, 31059, Toulouse, France
| | - Edith Brazet
- CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, 31059, Toulouse, France
| | - Agnès Sartor
- CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, 31059, Toulouse, France
| | - Isabelle Lacroix
- Centre Régional de Pharmacovigilance Midi-Pyrénées, 31000, Toulouse, France
| | | | | | - Olivier Parant
- CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, 31059, Toulouse, France. .,Université de Toulouse III, UMR1027, 31073, Toulouse, France. .,Inserm UMR1027, 31073, Toulouse, France.
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Singh VP, Singh N, Jaggi AS. A review on renal toxicity profile of common abusive drugs. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2013; 17:347-57. [PMID: 23946695 PMCID: PMC3741492 DOI: 10.4196/kjpp.2013.17.4.347] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/25/2013] [Accepted: 07/14/2013] [Indexed: 12/22/2022]
Abstract
Drug abuse has become a major social problem of the modern world and majority of these abusive drugs or their metabolites are excreted through the kidneys and, thus, the renal complications of these drugs are very common. Morphine, heroin, cocaine, nicotine and alcohol are the most commonly abused drugs, and their use is associated with various types of renal toxicity. The renal complications include a wide range of glomerular, interstitial and vascular diseases leading to acute or chronic renal failure. The present review discusses the renal toxicity profile and possible mechanisms of commonly abused drugs including morphine, heroin, cocaine, nicotine, caffeine and alcohol.
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Affiliation(s)
- Varun Parkash Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala-147002, India
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Chaudhari T, Robertson M, Ellwood D, Simpson E, Kecskes Z, Kent AL. Maternal ventilation and sedation for H1N1 influenza resulting in fetal bladder rupture and urinary ascites. J Paediatr Child Health 2013; 49:E97-100. [PMID: 22845898 DOI: 10.1111/j.1440-1754.2012.02502.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urinary ascites in a newborn infant is unusual and most commonly results from bladder perforation following umbilical arterial catheterisation or obstructive uropathy. The following report describes a case of fetal bladder rupture with urinary ascites in a mother ventilated and sedated with narcotics and benzodiazepines for H1N1 influenza. This was associated with a unique biochemical profile of hyponatraemia and elevated serum urea and creatinine characteristic of urinary autodialysis in the neonate.
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Affiliation(s)
- Tejasvi Chaudhari
- Department of Neonatology, Canberra Hospital, Woden, Australian Capital Territory, Australia
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Pogliani L, Mameli C, Cattaneo D, Clementi E, Meneghin F, Radice S, Bruno S, Zuccotti GV. Acute kidney injury in a preterm infant homozygous for the C3435T polymorphism in the ABCB1 gene given oral morphine. Clin Kidney J 2012; 5:431-3. [PMID: 26019822 PMCID: PMC4432415 DOI: 10.1093/ckj/sfs099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/13/2012] [Indexed: 01/04/2023] Open
Abstract
A 34-week infant born from a mother with a history of drug abuse developed neonatal abstinence syndrome (NAS) in the first hours of life. Urine drug screening was positive for cocaine and heroin. The infant developed acute kidney injury and bilateral hydronephrosis while receiving oral morphine for control of NAS. Cessation of morphine therapy and urinary catheterization resulted in a rapid and complete resolution of the symptoms. Our patient was homozygous for the C3435T polymorphism in the ABCB1 gene, a polymorphism previously associated with impaired P-glycoprotein activity. We hypothesize that acute renal toxicity was related to accumulation of morphine within urothelial cells due to genetically determined impaired P-glycoprotein activity.
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Affiliation(s)
- Laura Pogliani
- Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Chiara Mameli
- Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences , Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco Hospital, University of Milan , Milan , Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences , Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco Hospital, University of Milan , Milan , Italy ; E. Medea Scientific Institute , Bosisio Parini , Italy
| | - Fabio Meneghin
- Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences , Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco Hospital, University of Milan , Milan , Italy
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Palmer E, Oliveros M, Fong J, Graham G. Medication induced fetal bladder rupture: a case report. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ojog.2011.12004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Allegaert K, Smet M, Debeer A, Breysem L. Bladder catheter-induced obstructive bilateral hydroureteronephrosis in a newborn. Acta Paediatr 2010; 99:1747-9. [PMID: 20560898 DOI: 10.1111/j.1651-2227.2010.01915.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We describe a dynamic, bladder catheter-related obstructive bilateral hydroureteronephrosis in a newborn documented during ultrasound. The normal findings at foetal ultrasound and the absence of muscular hypertrophy of the bladder hereby served as indicators of the iatrogenic nature of the initial abnormal ultrasound findings. CONCLUSION A Foley bladder catheter can induce obstructive bilateral hydroureteronephrosis in newborns.
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Affiliation(s)
- Karel Allegaert
- Neonatal Intensive Care Unit and Department of Radiology, University Hospitals Leuven, Herestraat, Leuven, Belgium.
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Anderson MK, Day TK. Effects of morphine and fentanyl constant rate infusion on urine output in healthy and traumatized dogs. Vet Anaesth Analg 2008; 35:528-36. [DOI: 10.1111/j.1467-2995.2008.00413.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Khassawneh M, Al-Balas H. Renal impairment and hydronephrosis in a premature infant following morphine infusion: case report. Pediatr Nephrol 2008; 23:1887-8. [PMID: 18481104 DOI: 10.1007/s00467-008-0866-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 04/09/2008] [Accepted: 04/09/2008] [Indexed: 10/22/2022]
Abstract
This is a case report of an association between morphine administration and occurrence of hydronephrosis with acute renal failure. This premature female infant born at 27 weeks of gestation had moderate hydronephrosis with acute renal impairment while receiving morphine infusion for pain management after chest-tube insertion. All these findings were reversed after stopping morphine and urinary catheterization. Follow-up renal ultrasound and voiding cystourethrogram showed resolution of hydronephrosis with no evidence of vesicoureteral reflux. Morphine is associated with reversible hydronephrosis and renal impairment in premature infants.
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Bacchetta J, Cochat P. Le rein des anciens prématurés est-il menacé ? Arch Pediatr 2008; 15:1212-22. [DOI: 10.1016/j.arcped.2008.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 03/13/2008] [Accepted: 04/13/2008] [Indexed: 10/21/2022]
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Launay-Vacher V, Karie S, Fau JB, Izzedine H, Deray G. Treatment of pain in patients with renal insufficiency: The World Health Organization three-step ladder adapted. THE JOURNAL OF PAIN 2005; 6:137-48. [PMID: 15772907 DOI: 10.1016/j.jpain.2004.11.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The World Health Organization established official recommendations for managing pain in cancer patients. Since then, this stepladder approach has been widely adopted as a conceptual framework to treat all types of pain. However, those guidelines have not been critically evaluated for use in patients with renal insufficiency. In these patients, the questions of drug dosage adjustment and renal toxicity must be considered. This article reviews the pharmacokinetics of major analgesic drugs and data on their use and/or behavior in renal failure and considers their potential nephrotoxicity. Finally, according to available data in the international literature on pharmacokinetics, recommendations for dosage adjustment in patients with renal failure, and their potential nephrotoxicity, the World Health Organization three-step ladder for the treatment of pain was modified and adapted for patients with impaired renal function. Perspective This well-known treatment strategy now adapted for use in patients with renal insufficiency should secure and rationalize pain treatment in those patients.
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