Acute kidney injury due to pulmonary embolism: the case for 'congestive renal failure'

The development of acute kidney injury in patients with pulmonary embolism (PE) has not been well documented. We report a patient who developed acute oliguria in the setting of massive PE. Catheter embolectomy followed by ultrafiltration resulted in an immediate and dramatic improvement in urine output. Uncharacteristically, serum creatinine did not rise during the oliguric phase for several days until after embolectomy, and there were no metabolic derangements. Our observation that embolectomy and ultrafiltration helped with hemodynamics and renal perfusion despite decreased cardiac output suggests that right ventricular failure from both pressure and volume overload may have been central to this process. We review the older and recent literature in support of our observations.