A 77-year-old patient with diabetes mellitus 2 and hypertension.
He received losartan, metformin and glibenclamide.
Two days before admission she suffered sudden abdominal pain followed by syncope.
Subsequently, progressive reduction of diuresis (hematic) was observed until anuria.
She was admitted 24 hours later.
On physical examination there was nothing relevant.
Blood pressure was 198/86 mmHg and there was no tachycardia or fever.
There was hyperglycemia 331 mg/dl, nitrogen retention (uremia 116 mg/dl, creatinine 5.49 mg/dl), hyponatremia (120 mEq/L) and mild elevation of C-reactive protein.
Urine showed hematuria and leukocyturia.
Renal ultrasound showed normal-sized kidneys with diffuse increase in echogenicity.
Parenteral hydration and intestinal amyloidosis were indicated.
The next day, the patient continued to develop anuria, azotemia, metabolic acidosis, hyperkalemia, and anemia (hemate, 35%).
Calcium, phosphorus, LDH, leukocyte and platelet counts were normal.
A computed tomography of the abdomen and pelvis without contrast was requested, in the absence of an evident cause of renal failure.
It showed a filter in the inferior vena cava (IVC), immediately below the liver, duplication of the IVC and extensive thrombosis extending from the filter to the lower part of both renal vena cavae.
The kidneys and retroperitoneal tissue were edematous.
Doppler ultrasonography showed thrombosis in the IVC and showed a irregular flow through both renal veins.
Acute kidney injury secondary to bilateral thrombosis of the renal veins was diagnosed and therapy with unmet heparin was instituted.
1.
The patient had suffered from phlebothrombosis and pulmonary embolism 17 months ago in the post-operative period of a retinal detachment, for which a filter had been placed in the IVC therapy.
Five months before admission, during a health check-up, an increase in pro-specific antigen (PEA) was found (16 ng/ml) and anticoagulant therapy was suspended for a prostatic biopsy, which was not performed.
The concentration of PSA during hospitalization was 12 ng/ml.
On the third day of hospitalization the azotemia was higher and it became apparent.
On that day diuresis reappeared and in the following days polyuria (this 7 ml/24 h) occurred, with progressive reduction in azotemia.
One week after admission, oral anticoagulation with warfarin was initiated.
She was discharged 2 weeks after admission with recovery of renal function (creatinine 1.5 mg/dl, uremia 66 mg/dl).
