ESRD Patient's Elevated Beta-hCG: A Diagnostic Puzzle Before Transplant

Beta-human chorionic gonadotropin (beta-hCG) is a critical biomarker primarily used to detect pregnancy, especially before patients undergo significant diagnostic or therapeutic interventions. While a positive result typically confirms pregnancy, false-positive values are a known occurrence, particularly in women with chronic kidney disease (CKD). This case report addresses the specific knowledge gap regarding the diagnostic complexities of elevated beta-hCG in a young adult female patient with end-stage renal disease (ESRD) who was awaiting kidney transplantation, where initial pregnancy suspicion proved to be a false alarm.

Upon initial screening, the patient exhibited significantly elevated beta-hCG levels, immediately raising concerns for pregnancy and potentially delaying her crucial kidney transplantation. However, despite these initial findings, a thorough and iterative diagnostic process, which included repeated beta-hCG assays and advanced imaging techniques such as pelvic ultrasound, consistently failed to provide any evidence of gestation. The persistent elevation of beta-hCG was ultimately determined to be a non-specific finding directly attributable to her underlying end-stage renal disease and the associated impairment in renal clearance mechanisms. The most critical discovery was that the persistently elevated beta-hCG levels, which initially led to a strong suspicion of pregnancy, were unequivocally identified as a false positive phenomenon, directly resulting from the patient's severe renal failure, thereby highlighting a significant and potentially misleading diagnostic challenge in this specific patient population. This finding underscores that ESRD can lead to non-specific elevation of beta-hCG, complicating pre-procedural assessments and necessitating a careful differential diagnosis.