Abstract: FR-PO623
A 5-Month-Old Female with One Week of Anuria
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1600 Pediatric Nephrology
Authors
- Dixon, Angelina Magreni, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Lively-Endicott, Hannah Rebecca, University of Queensland/Ochsner Clinical School, New Orleans, Louisiana, United States
- El-Dahr, Samir S., Tulane University School of Medicine, New Orleans, Louisiana, United States
Introduction
Anuric AKI is typically associated with worse outcomes than AKI with preserved urine volume. Anuria usually suggests obstruction, but it can also be seen in ATN or AIN. Acute vascular catastrophe can also cause anuria; however, it must affect both kidneys or a single functioning kidney.
Case Description
We present the case of a 5-month-old, ex-24-week female transferred to our PICU from an outside hospital NICU with anuria. Ten days prior to transfer the patient’s creatinine had risen from 0.3 to 2.0 in five days with oliguria, and seven days prior to transfer the patient was noted to be anuric. A renal US demonstrated obliteration of the renal venous flow suggestive of thrombosis of the IVC and bilateral (BL) renal veins as well as high resistive flow in the main renal artery.
Upon admission, the patient had a BUN of 219 mg/dl and creatinine of 6.8 mg/dl. She was placed on CRRT. A repeat US confirmed IVC and BL renal vein thrombi, so a heparin drip was started. Subsequent catheterization demonstrated BL renal artery thrombi as well, so the patient underwent mechanical thrombectomy of her IVC and right renal vein in addition to site-directed TPA to her IVC, renal veins, and renal arteries. Ultimately, anticoagulation was not sustainable due to the development of severe coagulopathy, so the decision to withdraw support was made.
The etiology of this patient’s BL renal artery thrombi is still unclear. Our patient had a normal hypercoagulability workup; however, she had multiple central venous lines placed, including a catheter placed immediately before her creatinine began to drastically rise. In addition, she had a known PFO. Therefore, the most likely etiology of in this patient was central-line associated thrombus formation.
Discussion
Renal vascular occlusion leads to renal infarct in hours as collateral vasculature can only maintain adequate perfusion for a short period of time. Therefore, early diagnosis and treatment is imperative. Treatment is controversial and depends on the acuity of the situation. Most patients are treated with systemic anticoagulation. In recent reports, supportive care is recommended for unilateral vascular occlusion without extension into the IVC where thrombolytic agents were used for bilateral cases. The long-term benefit of this approach is still unclear.