Recurrent hydronephrosis causing acute uraemia in a renal transplant donor without the presence of stones or stricture.

his abdomen was tender with guarding. His CAPD fluid was tested using ‘dipstix’ testing and was found to be positive for bilirubin. The patient also had a chest X-ray, which showed air under the diaphragm. This can be normal in the CAPD population, but the chest X-ray was repeated after a temporary dialysis line was inserted and the air was no longer present. Due to the clinical picture and patient’s condition he was taken to theatre where a perforated duodenal ulcer was found. He had a protracted postoperative course with an ITU stay and multiple intraabdominal abscesses, but has now recovered. Normal methods for diagnosis including erect chest X-rays have been shown to be of limited use in these patients and are not a reliable indicator of visceral perforation [3]. One of the more common indicators of visceral perforation is multiple enteric organisms on culture of CAPD fluid. This in itself can take a few days, which is also delaying the patient’s treatment. We feel that the bedside testing of CAPD fluid for bilirubin may help with the diagnosis of visceral perforation. If we can shorten the time to surgery for these patients we may be able to make an impact on the mortality and morbidity.