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Kidney Week

Abstract: PO0279

AKI Associated with Hydrophilic Polymer Embolism: A Case Report

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ruiz Toledo, Alejandro Javier, UCF/HCA Healthcare GME, Greater Orlando, Orlando, Florida, United States
  • Hosseinian, Nima, UCF/HCA Healthcare GME, Greater Orlando, Orlando, Florida, United States
  • Qadir, Maryam, Orlando VA Healthcare System, Orlando, Florida, United States
Introduction

Minimally invasive endovascular procedures have become increasingly popular. Technology has improved, allowing the use of hydrophilic polymers to coat surgical tools such as catheters, guidewires, and sheaths to reduce vasospasm and trauma to vessels. However, a complication of using hydrophilic polymers is embolization of the material to distal small arteries, causing ischemia of organs such as the lung, brain and kidneys. Although hydrophilic polymer embolization has recently increased in recognition, only a few cases of renal embolization have been reported.

Case Description

Here we present the case of a 73-year-old male with history of peripheral artery disease and no previous diagnosis of kidney disease who was admitted to the hospital due to acute oliguric acute kidney injury (AKI), four weeks after undergoing an endovascular aneurysm repair with aorto-uni-iliac stent, right femoral endarterectomy and right femoral-popliteal bypass. Laboratory work-up such as complement levels, viral and antibody serologic testing were unremarkable. His hospital course was complicated by anuria, hyperkalemia and hyperphosphatemia. Kidney biopsy (figure 1) showed a foreign material consistent with a hydrophilic polymer embolism, as well as histiocytes with similar ingested foreign material, along with atheromatous emboli, and mild to moderate interstitial fibrosis. Treatment was supportive, including renal replacement therapy (RRT), with improvement in kidney function to the point of having adequate urinary output, no electrolyte derangements and no further need for RRT at discharge.

Discussion

In this case report, we compare our findings to other reported cases of hydrophilic polymer emboli to increase awareness of this under-recognized cause of organ dysfunction.

H&E stain showing arteriole occluded by hydrophilic polymer emboli.