Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy

Abstract

Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Continuing Medical Education online Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits TM . Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To receive credit, please go to http://www.medscape.com/cme/ncp and complete the post-test. Learning objectivesUpon completion of this activity, participants should be able to: 1 Describe the clinical features of pulmonary embolism in a pregnant woman. 2 Describe the clinical features of intravascular hemolysis. 3 Describe the mechanism of action of the AngioJet ® . 4 Review the management of acute kidney injury associated with hemolysis. Competing interestsThe authors, the Journal Editor C Harman and the CME questions author D Lie declared no competing interests. THE CASEA 43-year-old African-American female (gravida 5 para 0), with an intrauterine pregnancy of 8 weeks' gestation, presented to the emergency room with crampy abdominal pain, shortness of breath, and shoulder pain. The patient's medical history was notable for hypertension, uterine fibroids, one spontaneous abortion in the first trimester, and three elective therapeutic abortions. She was not taking any prescription medications and had no known drug allergies. The patient's history also indicated that she had smoked one pack of cigarettes per week for 25 years, but she denied alcohol or illicit drug use. On physical examination, the patient's temperature was 36.0 °C, and she had a pulse rate of 118 beats per minute and a blood pressure of 142/87 mmHg. Oxygen saturation was 100% on a nonrebreather mask. The patient was alert S u M M a rYBackground 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.

AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis

“…Early studies have demonstrated intravascular haemolysis following procedure with clinically insigni icant drops in Hb concentrations, elevated LDH and low haptoglobin consistent with haemolysis, and less frequently an increase in creatinine [8]. In 2009 [3] reported a presumed irst case of severe AKI requiring dialysis following AngioJet TM PMT in a patient with pulmonary embolus [3]. Prior to this in 2007, however, a prior paediatric case of AKI involving PMT had already been reported in a 16 year old patient with severe clot burden DVT and multiple administration of contrast resulting in severe AKI requiring peritoneal dialysis [9].…”

“…Although its bene it in upper limb DVT is less clear [2], the presence of a large symptomatic thrombus prompted decision to proceed with thrombolysis and PMT in addition to anticoagulation. Targeted therapy for thrombus dissolution also remains an attractive strategy in patients with signi icant bleeding risk or where systemic thrombolysis is not an option [3]. AngioJet TM , available at our facility, creates a hydrodynamic vortex through retrogradely oriented high speed luid jets allowing selective trapping and dissolving of thrombi [4].…”

Liefe-threatening haemolysis induced by henna in a Sudanese child with glucose-6-phosphate dehydrogenase deficiency

“…Intravascular haemolysis of various causes can result in acute tubular necrosis due to haemoglobinuria leading to acute renal failure (12). Our case showed no derangement in his renal function, which might because of his early presentation and degree of haemolysis.…”

Angiojet Rheolytic Thrombectomy in Massive Pulmonary Embolism: Locally Efficacious but Systemically Deleterious?

“…Hyperkalemia may exacerbate the electrical instability, and hemoglobinuria may cause further deterioration of kidney function in these patients already at risk of kidney failure because of hemodynamic instability and contrast medium administered for the ART procedure with or without diagnostic computed tomography angiography (8). The placement of a temporary pacemaker wire and the aggressive control of potassium levels are crucial during the ART procedure in patients presenting with massive PE.…”