Acute tubular necrosis

Case contributed by Dr Simon Rupret

Presentation

Acute presentation with shortness of breath, chest pain and hypoxia. STEMI on ECG and underwent PCI with stent and intra-aortic balloon pump insertion. On ITU, patient developed carcinogenic shock with pulmonary edema, they were intubated, the CVC and NG tube were placed to facilitate management.

Patient Data

Age: 70
Gender: Female

Plain chest radiograph 3 days post PCI

X-ray

Appropriately positioned ET tube, CVC and NG tube with features of pulmonary congestion and pericardial effusion.

Incidental finding of bright renal parenchyma, as well as contrast excretion in the colon. 

Case Discussion

As a part of their management, the patient underwent PCI with aortic balloon pump insertion.

Later on the same day, they developed cardiogenic shock post procedure with acute renal dysfunction and progressively worsening acute kidney injury, last eGFR 23.

Multiple chest radiographs showing changes of fluid overload were obtained over the following days.

The radiograph above was obtained 3 days following the PCI. There is exquisitely bright renal parenchyma secondary to the combination of large contrast volumes during PCI and acute tubular necrosis, preventing excretion of contrast via the collecting system. No contrast is seen in the collecting system due to tubular dysfunction.

Incidental high density descending colon due to vicarious contrast excretion.

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