The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding.

Abstract

This study was designed to assess the clinical factors associated with the development of acute kidney injury (AKI) in patients undergoing endovascular treatment during the course of severe renal bleeding. A retrospective analysis was performed of 36 consecutive patients who were treated endovascularly between January 2006 and December 2016 for anemia caused by iatrogenic (26pts) or posttraumatic (10pts) renal bleeding. Typical patient data, baseline, and postprocedural blood parameters were evaluated. As a predictor of AKI occurrence, SCr0>1.5mg/dL, eGFR<60ml/min/1.73m2, and Mehran score were evaluated. Fourteen patients (39%) developed AKI after CM injection. Time of hospitalization (p=0.02), hypotension (p=0.005), dialysis (p=0.05), blood transfusions (p=0.028), amount of blood received (p=0.003), red blood units>3 (RBU) (p=0.032), and CM>150ml (p=0.014) were related to AKI occurrence. The Mehran score may be used as a predictor of AKI occurrence (p=0.022). The SCr>1.5mg/dL and eGFR<60ml/min/1.73m2 were not statistically significant. Selective renal embolization (mean 34% loss of renal tissue) does not lead to AKI. Hypotension, anemia requiring blood transfusion, and administration of CM exceeding 150ml poses higher risk of AKI development, which leads to longer hospital stay and need of dialysis. The Mehran score may be used as predictor of AKI occurrence. Up to one third of the kidney was embolized with no AKI linked to the procedure. The concern of AKI occurrence should not be a cause of delay of endovascular treatment.