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August 26, 1974

Nephrogenous Ascites

JAMA. 1974;229(9):1214. doi:10.1001/jama.1974.03230470056031

End-stage renal failure with uremia is sometimes attended by bizarre accumulations of fluid, the pathogenesis of which is not altogether clear. Examples include pulmonary edema in which the fluid is located at the hilar regions, giving a roentgenographic picture characterized as "bat wing" or "butterfly wing," and pericarditis with effusion. At times, the pericardial effusion is so extreme as to cause cardiac tamponade, requiring emergency treatment by paracentesis or pericardiectomy.

A recent issue of Archives of Internal Medicine contains two communications that recount extraordinarily large and persistent accumulations of ascitic fluid in uremic patients. During a two-year period, Craig et al1 observed six patients with chronic renal failure and persistent ascites resistant to hemodialysis in five instances. (The sixth case must be discounted since the patient refused treatment and was lost to follow-up.) All six patients underwent peritoneoscopy that failed to disclose any factor other than the uremia to