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Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy

Nature Clinical Practice Nephrology volume 5, pages 112–116 (2009)Cite this article

Abstract

Background A 43-year-old African-American female (gravida 5 para 0) with an 8-week intrauterine pregnancy presented to the emergency room with crampy abdominal pain, shortness of breath, and shoulder pain. She had normal renal function on admission. CT angiography of the chest revealed bilateral pulmonary emboli; therefore, the AngioJet® (Possis Medical, Inc., Minneapolis, MN) device was used to perform mechanical thrombolysis. The patient subsequently developed hyperkalemia, red urine and anuria.

Investigations Physical examination, measurement of serum creatinine level and electrolytes, dipstick urinalysis and centrifugation of urine and blood.

Diagnosis Acute kidney injury due to hemoglobinuria as a result of non-immune-mediated intravascular hemolysis following the use of a percutaneous mechanical thrombectomy device (AngioJet®).

Management Hydration, alkalinization of urine and initiation of hemodialysis (temporarily switched to continuous venovenous hemodiafiltration). Urine output improved after the 20th day of hospitalization, at which point dialysis was discontinued. The patient's renal function completely recovered by day 25.

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Figure 1: Contrast-enhanced CT of the chest showing pulmonary emboli at the subsegmental level of the right and left pulmonary arteries.

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. EH Yang is a Fellow in the Division of Cardiology at Harbor-UCLA Medical Center, S Adler is Chief of the Division of Nephrology at Harbor-UCLA Medical Center and Professor of Medicine at the David Geffen School of Medicine at UCLA and J Vintch is Associate Professor of Medicine at the David Geffen School of Medicine at UCLA and Associate Program Director of Internal Medicine at the Harbor-UCLA Medical Center, R Dukkipati is Medical Director of Interventional Nephrology at Harbor-UCLA Medical Center and Assistant Professor of Medicine at the David Geffen School of Medicine at UCLA, Torrance, CA, USA.,

    Ramnath Dukkipati, Eric H Yang, Sharon Adler & Janine Vintch

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  1. Ramnath Dukkipati
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  2. Eric H Yang
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Correspondence to Ramnath Dukkipati.

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The authors declare no competing financial interests.

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Dukkipati, R., Yang, E., Adler, S. et al. Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Nat Rev Nephrol 5, 112–116 (2009). https://doi.org/10.1038/ncpneph1019

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