Kidney Week

Abstract: SA-PO0369

Bilateral Renal Infarction/Cortical Necrosis Causing Dialysis-Dependent AKI with Recovery After Exchange Transfusion

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

• Phocco, Erick, St. Barnabas Hospital, Bronx, New York, United States

Erick Phocco, MD

• Taveras, Patxis, St. Barnabas Hospital, Bronx, New York, United States

Patxis Taveras, MD

• Paula, Ricaudy R., St. Barnabas Hospital, Bronx, New York, United States

Ricaudy R. Paula, MD

• Salvador, Tania E., St. Barnabas Hospital, Bronx, New York, United States

Tania E. Salvador, MD

• Broka, Andrea, St. Barnabas Hospital, Bronx, New York, United States

Andrea Broka, MD

• Ahmed, Abdurhman, St. Barnabas Hospital, Bronx, New York, United States

Abdurhman Ahmed, MD

• Flores Chang, Bessy Suyin, St. Barnabas Hospital, Bronx, New York, United States

Bessy Suyin Flores Chang, MD, FASN

Introduction

Sickle Cell Disease (SCD) is a known cause of chronic kidney disease secondary to repetitive vaso-occlusive episodes (VOE) affecting the renal medulla. Acute VOE can lead to acute kidney injury (AKI), although this is rare. We present the case of a young man with sickle cell crisis leading to renal failure requiring hemodialysis

Case Description

25-year-old male with history of SCD presented with generalized tenderness after being assaulted. Found to be have a hemoglobin of 5.5 g/dL, a reticulocyte count of 8.35% and a LDH of 2605 IU/L; a creatinine of 9.9 mg/dL and a BUN of 124 mg/dL with hyperkalemia and metabolic acidosis. Baseline creatinine was within normal limits. Peripheral smear showed schistocytes. CT of the abdomen and pelvis showed multiple bilateral renal infarcts with cortical necrosis. Renal ultrasound showed loss of definition of the corticomedullary junction in both kidneys

Started on hemodialysis due to refractory hyperkalemia and acidosis. Exchange transfusion was performed for management of sickle cell crisis. Required one day of Continuous Renal Replacement Therapy and 8 sessions of hemodialysis. 17 days after exchange transfusion was done HD was discontinued in view of increasing urine output and improvement in serum creatinine. Patient renal function continued to improve, reaching a creatinine of 1.9 mg/dL on discharge

Discussion

Renal infarction with cortical necrosis is a rare manifestation of sickle cell vaso-occlusive crisis and can result in dialysis-dependent AKI. Early recognition and prompt initiation of exchange transfusion and renal replacement therapy was associated with substantial recovery of renal function. This case highlights the importance of considering renal vaso-occlusive complications in sickle cell patients presenting with severe AKI

CT of abdomen and US of right kidney