An ileal neobladder urinary leak mimicking rapidly progressive glomerulonephritis

Urinary leak is a known postoperative complication, occurring usually within the first months after surgical creation of an ileal neobladder following cystectomy. We describe the case of a 54-year old man who, ten years after creation of a continent and fully functioning ileal neobladder, presented with abdominal pain and dysuria. This was associated with nephrotic range proteinuria, microscopic hematuria and a rapid rise in serum creatinine, mimicking a rapidly progressive glomerulonephritis. Following an extensive nephrological workup, including a kidney biopsy that yielded normal results, urological evaluation including a pouchogram was performed revealing an ileal neobladder urinary leak. It was postulated that a urinary tract infection must have caused the clinical symptoms, the proteinuria and hematuria and the urinary leak caused acute renal failure with reabsorption of retention solutes via the peritoneal cavity. The case is discussed and the available literature, with special focus on late ileal neobladder urinary leaks, is critically reviewed. We can conclude that there is little information on characteristic urinalysis findings, particularly proteinuria, from patients with an ileal neobladder in healthy and disease states such as urinary tract infection.