A 67-year-old woman with multiple risk factors: hypertension, hypercholesterolemia, dysglucosis, obesity, acute coronary syndrome, etc.
He has a single left kidney with stenosis due to stage 3 chronic kidney disease (KG/DOQUIGs) secondary to ischemic nephropathy with preserved diuresis.
Angiographically, it presents a critical stenosis of the left renal artery and uncontrolled hypertension despite pharmacological treatment with quinttuple therapy (angiotensin-converting enzyme inhibitors, beta-blockers, diuretics and alpha-blockers).
Previous tests showed creatinine of 1.9-2.4 mg % and blood pressure (BP) rebel.
Its anesthetic risk is moderate, and surgery is scheduled for stent placement in the left renal artery under locoregional anesthesia with continuous blood pressure monitoring.
During surgery, the patient is hemodynamically stable, with sustained diuresis.
During the postoperative period she begins with sudden severe pain in the left renal fossa accompanied by hypotension, vegetative symptoms and sudden oligoanuria.
Subsequently, the patient developed chest pain radiating to the back without changes in electrocardiogram or elevation of cardiac markers.
However, treatment for ischemic heart disease is initiated.
If a stent thrombosis is suspected, an arteriography is performed via the left femoral artery confirming renal artery thrombosis (thrombolysis is attempted without achieving it) and stent migration is attempted unsuccessfully.
During the procedure she is hemodynamically oriented and needs active drugs and blood transfusion; in anuria, with increased urea and creatinine, so a dialysis catheter is implanted.
The patient required high doses of medication to maintain atrial fibrillation, elevated anuria with urea and creatinine levels and echocardiography that ruled out a cardiogenic component.
He had coagulation disorders without evidence of active bleeding and rapid clinical deterioration with mechanical ventilation-dependent respiratory failure.
Abdominal computed tomography showed the presence of a retroperitoneal hematoma, performing urgent laparotomy.
The shock patient was immediately afflicted with distributive shock refractory to vasoactive drugs, systemic inflammatory response syndrome and anuric renal failure, resulting in a situation of multiple organ failure secondary to renal ischemia.
