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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Percutaneous mechanical thrombectomy (PMT) is increasingly used for acute deep venous thrombosis (DVT).
  • PMT aims to reduce pulmonary embolism and post-thrombotic syndrome (PTS) risks.
  • Reversible acute kidney injury (AKI) from hemoglobinuria post-PMT has been reported with good prognosis.

Observation:

  • A patient with extensive lower extremity DVT developed AKI post-PMT.
  • The patient exhibited hemoglobinuria and required prolonged hemodialysis (HD) for 5 months.
  • Pre-procedure renal function was normal.

Findings:

  • This case demonstrates that a large thrombus burden during PMT can lead to severe, prolonged AKI requiring extended HD.
  • Hemoglobinuria-associated acute tubular necrosis is the likely pathophysiology.
  • The patient's outcome suggests AKI post-PMT may not always be reversible.

Implications:

  • Consider limiting PMT duration and monitoring effluent to mitigate AKI risk.
  • Quantifying hemolysed effluent may help prevent severe renal injury.
  • Further research is needed to establish guidelines for safe PMT procedures to prevent severe AKI.