Abstract: SA-PO285
Aminocaproic Acid Induced Anuria
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 103 AKI: Mechanisms
Authors
- Amjad, Salah-ud-din, Virginia Commonwealth University, Richmond, Virginia, United States
- Kidd, Jason M., VCU Medical Center, Richmond, Virginia, United States
Introduction
59 year old woman with leukemia and severe thrombocytopenia developed acute kidney injury following treatment with Aminocaproic acid.
Case Description
A 59 year old female with leukemia and severe thrombocytopenia developed the acute onset of bilateral lower back pain. Prior to this, she had been receiving Aminocaproic acid (Amicar) for epistaxis and easy bruising related to her thrombocytopenia (platelets < 2000 repeatedly). Subsequently, she became anuric and serum creatinine increased from 0.55 mg/dl to 1.98 mg/dl. Potassium was 6 mEq/L. A renal sonogram showed bilateral hydronephrosis. A foley catheter was placed with minimal output. Contrast tomography was performed with IV contrast and showed no masses or hematoma. Urology was consulted and was initially hesitant to perform invasive testing due to her thrombocytopenia and immune suppressed state. She was started on dialysis for management of hyperkalemia. She ultimately underwent cystourethroscopy and was found to have clots bilaterally obstructing the ureteral openings in the bladder without any other filling defects. In the following 2-3 days, urine output began to increase with improved clearance and intermittent dialysis was stopped. Patient had full renal recovery.
Discussion
We believe this case has important clinical relevance due to the use of aminocaproic acid leading to obstruction and need for short term dialysis. Recognizing the clinical presentation of Amicar related renal failure can help direct the care and provide resolution such as in our case. It is known that in patients with upper urinary tract bleeding, the use of Amicar has resulted in intrarenal obstruction in the form of glomerular capillary thrombosis or clots within the renal pelvis and ureters. Keeping this in mind, benefits should outweigh the risks if Amicar is to be used. A question to be asked is the adverse effect of renal failure dose related or is it merely due to exposure of the drug. An important point to remember is that Amicar is renally excreted which would change dosing in a patient with pre-existing renal dysfunction or would need dynamic dose regulation in someone who suffers new kidney injury while on the drug. Contrast Induced injury was less likely in our patient due to acute kidney injury occurring earlier than expected in CIN. Also, renal recovery occurring after obstruction was corrected is more of a reason that renal injury was due to Amicar related obstructive uropathy.