Histotripsy-Induced Acute Kidney Injury Following Liver Tumor Treatment: A Preliminary Report of 9 Cases

Histotripsy is an ablation modality that induces mechanical tissue destruction via cavitation. This study aimed to evaluate the real-world incidence and characteristics of histotripsy-associated acute kidney injury (HAKI). Five medical centers were surveyed for cases of HAKI within 30 days of histotripsy. Among 146 procedures, 9 patients (6.2%) developed Grade 1, 2, or 3 HAKI and Society of Interventional Radiology Grade 3 (n = 4), 4 (n = 2), or 5 (n = 2) adverse events. Cases were associated with multiple overlapping treatments and discrepancies between planned (22.3 mL) and actual (58.3 mL) treatment volumes. This preliminary case series demonstrates that renal injury can occur following histotripsy; the presence of brown urine after treatment may be predictive, and large cumulative/overlapping treatment volumes may represent a risk factor. Further investigation appears warranted to better define prevalence, identify risk factors-including threshold treatment zone volumes-and develop evidence-based strategies for prevention and management.