Renal venous congestion following hemorrhagic shock due to traumatic liver injury
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CASE REPORT
Renal venous congestion following hemorrhagic shock due to traumatic liver injury Tomoki Taniguchi1 · Yoshihiro Fujimoto1 · Hironori Yawata1 · Masahito Horiguchi1 · Byongmun An1 · Tetsuro Takegami1 · Kenichiro Takashina1 Received: 29 April 2020 / Accepted: 24 September 2020 © Japanese Society of Nephrology 2020
Abstract A 78-year-old woman who sustained traumatic liver injury with hemorrhagic shock was hospitalized. She was admitted to the ICU after blood transfusion and emergent angiography. AKI was observed on the following day. Blood transfusion was continued because initial assessment was prerenal AKI due to hypovolemia. Despite transfusion of blood products and administration of diuretics, aggravated renal dysfunction, and low urine output continued, resulting in respiratory failure due to pulmonary edema. Renal venous congestion was suspected as the primary cause of AKI, since IVC compression from a hematoma with IVC injury was observed on CT imaging captured on admission, and renal Doppler ultrasonography demonstrated an intermittent biphasic pattern of renal venous flow. It was finally concluded that renal venous congestion resulted from IVC compression, since urine output increased remarkably after RRT without additional diuretics, and follow-up CT and renal Doppler ultrasonography revealed improvements in IVC compression and renal venous flow pattern, respectively. Renal venous congestion has been often reported to be associated with acute decompensated heart failure and, to our knowledge, this is the first report to describe trauma-induced renal venous congestion. Trauma patients are at risk for renal venous congestion due to massive blood transfusion after recovery from hemorrhagic shock; therefore, if they develop AKI that cannot be explained by other etiologies, physicians should consider the possibility of trauma-induced renal venous congestion and perform renal Doppler ultrasonography. Keywords Trauma · Venous congestion · AKI · Renal doppler ultrasonography
Introduction Acute kidney injury (AKI) occurs in 18.1–50% of trauma patients admitted to the intensive care unit (ICU) [1, 2]. The management of AKI is important because it is one of several factors associated with poor prognosis in ICU patients [3]. The pathophysiology of trauma-related AKI includes renal damage due to external force, hemorrhagic shock, abdominal compartment syndrome, rhabdomyolysis, and contrastinduced nephropathy [4]. Recently, renal venous congestion due to an increase in central venous pressure has attracted attention as an important cause of intrinsic AKI [5–7]; however, to our knowledge, there have been no reports describing trauma-induced renal venous congestion. We report a * Tomoki Taniguchi [email protected] 1
Emergency Department, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
case of trauma-induced renal venous congestion where the inferior vena cava (IVC) was compressed by a hematoma following traumatic liver injury.
Case report A 78-year-old woman, with a history of hypertens
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