Acute kidney injury requiring renal replacement therapy due to severe hemolysis after mechanical thrombectomy

Bedi, Puneet; Addanki, Daniel; Reichman, Aaron; Chou, Shyan–Yih; Reiser, Ira W.

doi:10.5430/crim.v3n4p87

Cited by 4 publications

(8 citation statements)

References 15 publications

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“…The case presented appears typical when compared to other reported cases of significant AKI following Angio-Jet ® [4][5][6][7][8]. Our patient developed AKI immediately postprocedure with associated haematuria and evidence of haemolysis, despite aggressive intravenous rehydration.…”

Section: Discussionsupporting

confidence: 62%

“…AngioJet ® has previously been shown to universally result in postprocedural gross haematuria, following intravascular haemolysis caused by the high-pressure saline jets [11]. Furthermore, previous cases of AKI secondary to AngioJet ® -induced intravascular haemolysis have also been reported [4][5][6][7][8]. The occurrence of haemolysis in the case presented, as evidenced by the passage of dark red urine post-procedure, fall in haemoglobin and haptoglobin, and rise in serum LDH, was an anticipated consequence of the procedure.…”

Section: Discussionmentioning

confidence: 68%

“…This in turn can cause acute kidney injury (AKI), which although an increasingly recognized complication of Angiojet ® , remains underappreciated in clinical practice. Five previous cases of AKI following Angiojet ® have been reported in the literature, one of which was in a child [4][5][6][7][8]. We report the case of a 29 year old male who developed a severe Stage 3 AKI [9], requiring renal replacement therapy (RRT), following AngioJet ® thrombectomy of an occluded iliac vein stent.…”

Section: Introductionmentioning

confidence: 98%

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Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

et al. 2021

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Background AngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet® has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJet® thrombectomy and post-procedure developed a stage 3 Acute kidney injury (AKI.) requiring renal replacement therapy (RRT), secondary to intravascular haemolysis. We aim to explore the mechanism and potential risk factors associated with developing AKI in these patients and suggest steps to optimise patient management. Case presentation A 29 year old Caucasian male who developed a stage 3 AKI, requiring RRT, following AngioJet® thrombectomy for an occluded femoral vein stent. Urine and laboratory investigations showed evidence of intravascular haemolysis, which was the likely cause of AKI. Following a brief period of RRT he completely recovered renal function. Conclusions AKI is an increasingly recognised complication following AngioJet® thrombectomy, but remains underappreciated in clinical practice. AKI results from intravascular haemolysis caused by the device. Up to 13% of patients require RRT, but overall short-term prognosis is good. Pre-procedural risk factors for the development of AKI include recent major surgery. Sodium bicarbonate should be administered to those who develop renal impairment. Renal biopsy is high risk and does not add to management. Increased clinician awareness and vigilance for AKI post-procedure can allow for early recognition and referral to nephrology services for ongoing management.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 98%

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Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

et al. 2021

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“…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]. More recently in 2016 a further case of AKI requiring dialysis following PMT treatment of an extensive lower limb and IVC DVT [10] was reported. Our case adds to a growing case series of severe AKI requiring short to medium term RRT.…”

Section: Introductionmentioning

confidence: 99%

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

Hultin¹,

Tam²,

Karumathil³

2018

J Clini Nephrol

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Background: AngioJet TM rheolytic thrombectomy has been used in the treatment of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome. Though not widely appreciated, it has the potential to cause intravascular haemolysis.Report: A 37 year old man with no previous medical history presented to his GP with a three week history of progressive right upper limb swelling. Doppler imaging confi rmed right upper limb DVT and CT scan demonstrated thoracic outlet syndrome. The patient underwent AngioJet TM thrombectomy followed by IV heparin infusion. Successful revascularisation of the occluded vein was achieved. Overnight he developed haematuria, which was initially attributed to IV heparin. Urinalysis however revealed no red cells or casts. Apart from an Hb drop from 134 to 117 his blood profi le and blood fi lm showed no abnormality. He subsequently developed progressive oliguria with marked oedema and acute kidney injury (AKI). His creatinine peaked at 1070umol/l at 96 hours post procedure and he was started on intermittent dialysis. He remained dialysis dependent for 6 days. Ultrasound imaging excluded urinary obstruction. Autoimmune and vasculitic serology were negative. Intravascular haemolysis and haemoglobinuria was confi rmed by raised LDH (1714u/L) and low haptoglobin (<0.1units). Direct Coomb's test, Cold agglutinin test and paroxysmal nocturnal haemoglobinuria screen were negative. The patient's renal function normalised over 3 months. Conclusions:The likely cause of this man's AKI is heme pigment nephropathy from intra-vascular haemolysis. Increased awareness of this condition may allow early identifi cation and intervention to reduce the risk of renal injury from AngioJet TM associated haemolysis.

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“…Although postprocedural hemolysis and hemoglobinuria are common, developing severe AKI requiring renal replacement therapy is an infrequent complication. Four of these cases occurred after PMT for venous thrombosis (Arslan et al 2007;Bedi, and Daniel, and Reichman, Aaron, and Chou, Shyan-Yih, and Reiser, Ira 2018;Mathews et al 2011;Sebastian et al 2018) and one following PMT for pulmonary embolism (Dukkipati et al 2009). We found no published cases reporting AKI after AngioJet PMT for peripheral arterial thrombosis.…”

Section: Discussionmentioning

confidence: 69%

Acute kidney injury following percutaneous mechanical thrombectomy of subclavian artery stent graft thrombosis: a case report

et al. 2020

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Background: Percutaneous mechanical thrombectomy (PMT) is a well-established technique for treatment of acute arterial and venous thrombosis which inevitably leads to intravascular erythrocyte hemolysis, resulting in hemoglobinuria. Case presentation: We present a case of 66-year-old Caucasian female with subclavian artery aneurysm causing distal embolization and hand ischemia. The aneurysm was treated with stent graft, but with a subsequent graft thrombosis 3 months later. After graft recanalisation, AngioJet PMT was performed which resulted in dialysisrequiring acute kidney injury. Conslusion: Only several cases of acute kidney injury following AngioJet PMT have been published in literature. To our knowledge, this is the first reported case of dialysis-requiring AKI after PMT for peripheral arterial thrombosis. Until there is sufficient evidence and recommendation on preventing AKI in this setting, we believe that by being aware of the risk and by monitoring of patient, one might minimize the damage in case it occurs.

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Acute kidney injury requiring renal replacement therapy due to severe hemolysis after mechanical thrombectomy

Cited by 4 publications

References 15 publications

Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

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

Acute kidney injury following percutaneous mechanical thrombectomy of subclavian artery stent graft thrombosis: a case report

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