Abstract: SA-PO0352
Acute Renal Failure Secondary to Intravascular Hemolysis from Pulsed Field Ablation
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Sheard, Hunter, Overland Park Regional Medical Center, Overland Park, Kansas, United States
- Kamerzell, Timothy, Quivira Internal Medicine, Overland Park, Kansas, United States
Introduction
Pulsed Field Ablation (PFA) is a newer form of ablation that uses nonthermal energy to ablate the foci causing arrhythmias. Acute kidney injury is a rare and serious but often overlooked complication of this specific type of ablation. Below, we present a case of acute renal failure secondary to intravascular hemolysis following PFA for atrial fibrillation.
Case Description
A 74-year-old female with a history of atrial fibrillation presented for elective ablation. Preoperative lab values showed a creatinine of 0.8 mg/dL, blood urea nitrogen (BUN) 21 mg/dL, estimated glomerular filtration rate (eGFR) 77.3, hemoglobin 14.8 g/dL, and hematocrit 42.8%. No immediate complications were reported after the procedure. The following morning, repeat lab values showed creatinine 2.6 mg/dL, BUN 43 mg/dL, eGFR 18.8, and hemoglobin 12.6 g/dL and the patient was reporting no new complaints. Urinalysis showed elevated protein, 3+ blood without red blood cells, and a moderate number of granular casts. Urine protein/creatinine ratio (UPCR) was 5.82g/g. Her fractional excretion of sodium was calculated at 8.1%.
Renal ultrasound and abdominal CT did not reveal any structural abnormalities of the kidneys. Her lab results prompted evaluation for hemolysis, which revealed elevated lactate dehydrogenase at 746 and a decreased haptoglobin at <8mg/DL. Peripheral blood smear did not show evidence of schistocytes. Management was largely supportive, including intravenous and oral fluids. The patient’s urine output was closely monitored and remained appropriate throughout admission. Repeat urinalysis performed several days post-ablation showed resolution of granular casts and improvement in her UPCR to 0.22 g/g. Her creatinine peaked at 6.2 mg/dL and was down trending at the time of discharge.
Discussion
This case demonstrates one possible complication of PFA, despite its relatively safe complication profile. Although this patient was able to fully recover with only supportive treatment, a patient with more comorbidities such as preexisting kidney disease may have required further intervention such as urgent hemodialysis. As such, the possibility of acute renal failure should be taken into consideration for patients who are undergoing PFA, and other forms of management should be considered. Post-operative chemistries, blood counts, and urine output should be monitored closely, especially in patients at higher risk for complications.
Acknowledgment
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.