IMAGENS EM MEDICINA / IMAGES IN MEDICINE

 

Anuric Acute Kidney Injury: A Diagnosis Not to Forget

Lesão Renal Aguda Anúrica: Um Diagnóstico a Não Esquecer

Rachele Escoli, Paulo Santos

Serviço de Nefrologia, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal

Correspondência

 

Keywords: Acute Kidney Injury; Anuria; Aortic Diseases; Thrombosis

 

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Palavras-chave: Anúria; Doenças da Aorta; Lesão Renal Aguda; Trombose

 

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A 66-year-old man, heavy smoker, with medical history of hypertension and peripheral arterial disease, presented to the emergency department with anuria. The physical examination revealed signs of fluid overload and laboratory showed serum urea 183 mg/dL (15-45), serum creatinine 9.6 mg/dL (0.4-1.0), hemoglobin 14.1 g/dL (12.0-15.0), potassium 5.2 mmol/L (3.6-5.1), LDH 509 U/L (0-247). A renal ultrasound with Doppler suggested asymmetric kidneys and doubtful renal arterial perfusion. A computed tomography (CT) angiography was then performed and confirmed abdominal aortic thrombosis with complete lumen occlusion in the emergency of renal arteries (see white arrow in Fig 1 Fig 2), with revascularization of the lower limbs by large collaterals and permeability of the celiac trunk and the superior mesenteric artery. He started haemodialysis. Vascular surgery evaluated the patient and there was no surgical feasibility given the high probability of unviable renal parenchyma. He was then anticoagulated, remained on hemodialysis and three year later he still keeps his daily life activities without intermittent claudication despite the abdominal aortic thrombosis.

 

 

 

 

This image intends to illustrate a rare cause of acute kidney injury (AKI). Although classically the clinical presentation may vary from acute limb ischemia, neurologic symptoms of the lower extremities and abdominal symptoms,¹ in this case the patient just presented with anuric AKI and nowadays he still has no lower limbs or abdominal involvement, despite being on hemodialysis.

Referências

Kaschwich M, Behrendt CA, Tsilimparis N, Kölbel T, Wipper SH, Debus ES. Management of acute aortic thrombosis. J Cardiovasc Surg. 2017 ;58:31320. doi: 10.23736/S0021-9509.16.09798-6.

 

 

Correspondência:Rachele Escoli rachele_escoli@hotmail.com
Serviço de Nefrologia, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal
Rua Xanana Gusmão 45 - 2350-754 Torres Novas

 

Conflitos de Interesse: Os autores declaram a inexistência de conflitos de interesse na realização do presente trabalho.

Fontes de Financiamento: Não existiram fontes externas de financiamento para a realização deste artigo.

Direito à Privacidade e Consentimento Informado: Os autores declaram que nenhum dado que permita a identificação do doente aparece neste artigo.

Proteção de Seres Humanos e Animais: Os autores declaram que não foram realizadas experiências em seres humanos ou animais.

Conflicts of interest: The authors have no conflicts of interest to declare.

Financing Support: This work has not received any contribution, grant or scholarship.

Confidentiality of data: The authors declare that they have followed the protocols of their work center on the publication of data from patients.

Protection of human and animal subjects: The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).

 

Recebido: 09/04/2018

Aceite: 17/15/2018