FROM DIALYSIS TO RECOVERY: RENAL REVERSAL AFTER SURGICAL INTERVENTION FOR INFERIOR VENA CAVA OBSTRUCTION

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

Am J Kidney Dis

Abstract

Vascular obstruction can cause severe kidney injury, leading to outcomes such as the need for dialysis. In some cases, surgical intervention to relieve such obstructions can result in significant renal recovery, even in patients with advanced kidney impairment. An 84-year-old male with a history of stage 3b chronic kidney disease (CKD) presented with right-sided abdominal pain and chest pain. Imaging revealed multiple hepatic cysts, with the largest measuring 12.3 x 16.2 x 14.7 cm. His hospital course was further complicated by supraventricular tachycardia (SVT), with heart rates exceeding 200 beats per minute, along with new-onset heart failure with reduced ejection fraction. An attempt at SVT ablation was aborted after the discovery of bilateral femoral vein thrombosis. Interventional radiology was consulted for inferior vena cava (IVC) filter placement, but a venogram revealed severe narrowing of the intrahepatic IVC due to extrinsic compression from the large hepatic cyst. Additionally, the infrarenal IVC was occluded due to complete thrombosis, with multiple collateral veins, preventing the placement of an IVC filter. During this time, the patient developed oliguric acute kidney injury (AKI), necessitating the initiation of dialysis. Over the following days, he underwent bilateral lower extremity and caval thrombectomy, along with hepatic cyst decompression and drain placement. Post-procedure, the patient showed significant improvement in renal function, allowing for successful weaning from dialysis. His renal function ultimately stabilized at stage 4 CKD. The resolution of vascular obstruction resulted in a remarkable recovery of renal function in a patient with AKI who initially required dialysis. Vascular obstruction, particularly involving the IVC, increases venous pressure, causes renal congestion, and impairs renal perfusion. Following infrarenal thrombectomy and suprarenal cyst decompression, the patient no longer required dialysis, an outcome rarely seen in the literature for such severe and multifactorial renal impairment. This case underscores the importance of early identification and intervention of underlying vascular pathologies to restore renal function and potentially prevent long-term dialysis dependence.

Volume

85

Issue

4

First Page

S46

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