Abstract: FR-PO1241
AKI After Hepatic Histotripsy: A Novel Onconephrology Complication
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Bhutta, Salman, Northwell Health, New Hyde Park, New York, United States
- Kuruvada, Krishna Mohita, Northwell Health, New Hyde Park, New York, United States
- Wanchoo, Rimda, Northwell Health, New Hyde Park, New York, United States
- Jhaveri, Kenar D., Northwell Health, New Hyde Park, New York, United States
Introduction
Histotripsy is a noninvasive, nonthermal focused ultrasound technique that destroys tissue via acoustic cavitation. Clinical trials have demonstrated favorable safety profiles without reported AKI, but real-world renal complications remain poorly characterized
Case Description
A 61-year-old male with stage IV colorectal cancer with liver metastases, diabetes, and hyperlipidemia—status post colectomy, hepatic resection, chemotherapy (FOLFOX/FOLFIRI-based), radiation, and recent capecitabine—underwent histotripsy for a 2.2 × 2.2 × 2.0 cm segment 5 lesion. The procedure was performed under general anesthesia with treatment of 17.3 cc over ~30 minutes. There were no peri-procedural complications: no hypotension, nephrotoxin exposure, NSAID use, or significant blood loss, and urine output remained stable.
Baseline serum creatinine (SCr) was 0.87 mg/dL. Two days post-procedure, SCr increased to 3.24 mg/dL (KDIGO stage 3 AKI), prompting hospitalization. The patient remained hemodynamically stable and euvolemic. Urinalysis demonstrated trace proteinuria and microscopic hematuria (8 RBCs/hpf) without casts; urine protein-to-creatinine ratio was 0.3. Urine sodium was 47 mEq/L with fractional excretion of sodium 1.4% and urea 49.3%, consistent with intrinsic injury. Serologic evaluation (ANA, ANCA, anti-GBM), complement levels, and monoclonal studies were normal. Creatine kinase was normal, and kidney ultrasound showed no obstruction. With intravenous hydration alone, SCr improved to 2.66 mg/dL within 24 hours and normalized to 1.06 mg/dL within 10 days, with complete resolution of hematuria.
Discussion
This case highlights AKI as a potential complication of histotripsy despite absence of traditional risk factors. Proposed mechanisms include pigment-mediated tubular injury from cavitation-induced hemolysis, tubular toxicity from cellular debris, or inflammatory-mediated injury. Histotripsy-associated AKI may be underrecognized. Routine post-procedural renal monitoring and preventive strategies such as adequate hydration and avoidance of nephrotoxins should be considered.