Common causes of acute kidney injury in SCD
What are the common causes of acute kidney injury (AKI) in patients with SCD?
• AKI may occur more frequently among patients with acute chest syndrome than those with a painful crisis. Predisposing factors leading to AKI include volume depletion due to concentrating defects, sickling process, and hemolysis. Patients may present with acute tubular necrosis from volume depletion or sepsis, tubular injury from ischemia-induced rhabdomyolysis, hemosiderin accumulation, or chronic use of nonsteroidal antiinflamatory drugs, kidney vein thrombosis, or, in rare cases, hepatorenal syndrome due to liver failure associated with the sickling process per se or transfusion-associated complications.
• Kidney infarction and papillary necrosis: Severe ischemia can lead to kidney infarction and papillary necrosis. Papillary necrosis typically presents as painless gross hematuria, but may be complicated by obstructive uropathy and urinary tract infections. Current data suggest that hematuria and papillary necrosis do not portend greater risk for kidney failure. Acute segmental or total kidney infarction may present with flank or abdominal pain, nausea, vomiting, fevers, and presumably renin-mediated hypertension.