Hemolysis and Acute Kidney Failure

Abstract

Deposits of iron and hemosiderosis in the kidney have been observed in diseases with intravascular hemolysis, including paroxysmal nocturnal hemoglobinuria, and valvular heart diseases and prosthetic heart valve implants. However, the decrease in kidney function associated with hemolysis caused by cardiac valvular disease or prostheses is less well recognized. We present a case of intravascular hemolysis after repair and banding of the mitral valve that resulted in massive renal tubular deposition of hemosiderin with decreased kidney function. We discuss the pathophysiologic process of both acute and chronic tubular injury from heme and heme proteins, including injury to organelles resulting in autophagic vacuoles containing damaged organelles, such as mitochondria. We conclude that tubular injury resulting from heme proteins should be considered as a cause of decreased kidney function in all patients with a cardiac valvular disease or prosthesis.

AKI Associated with Macroscopic Glomerular Hematuria

“…Renal hemosiderosis can also be found in hemolysis due to prosthetic heart valves and sickle cell hemoglobinopathies. Superimposed AKI has been described in a patient with underlying CKD who developed intravascular hemolysis associated with mitral valve repair (32). It was hypothesized that CKD may predispose to heme-induced injury.…”

Impact of Intravascular Hemolysis in Malaria on Liver Dysfunction

“…The supernatant was then centrifuged at 270 ϫ g for 10 min. To remove erythrocytes, the pellet was then suspended in 0.83% (w/v) NH 4 Cl and kept for 5 min after which it was again centrifuged at 480 ϫ g for 10 min. Finally, the cells were washed with Hanks' balanced salt solution by centrifugation at 270 ϫ g for 8 min and suspended in 1 ml of HBSS with 0.1% gelatin.…”

Acute Kidney Injury Due to Intravenous Bleach Injection

“…Massive hemolysis leads to excessive hemoglobin breakdown, overwhelming haptoglobin stores causing generation of free heme proteins. These heme breakdown products cause kidney injury by direct toxicity, reduced kidney blood flow, pigment cast formation, and subsequent tubular obstruction [11,12].…”