[Idiopathic ascites associated with hemodialysis. Case report and literature review]. / Ascitis idiopática asociada a hemodiálisis. Informe de un caso y revisión de la literatura.

BACKGROUND: Idiopathic dialysis ascites (IDA) is an uncommon disease characterized by the absence of a cause that can explain its presentation. CASE REPORT: Thirty year old female, with diabetic nephropathy under chronic hemodialysis, with massive ascites. Treatment with intensive ultrafiltration was non-successful, and we had poor clinical results with consecutive paracentesis. The study of ascitic fluid was normal. We discarded cardiovascular, hepatic, infectious, neoplastic, and metabolic etiologies and laparoscopy with hepatic and peritoneal biopsies were non-diagnostic. Finally, after renal transplantation, a rapid decrease of the ascites was observed and the diagnosis of IDA was established. DISCUSSION: IDA is a rare entity that does not seem to be related with uremia as it is usually present after the start of hemodialysis. Malnutrition and hypoproteinemia are frequently associated and could be part of the etiology of IDA, which explains the lack of response to ultrafiltration and salt restriction, usual treatment for ascites control. The pathophysiological explanation of the dramatic response of this patients to renal transplantation is unclear.