A 78-year-old woman who sustained traumatic liver injury with
hemorrhagic shock was hospitalized. She was admitted to the ICU after
blood transfusion and emergent angiography. AKI was observed on the following day.
Blood transfusion was continued because initial assessment was prerenal AKI due to
hypovolemia. Despite transfusion of blood products and administration of
diuretics, aggravated renal dysfunction, and low urine output continued, resulting in
respiratory failure due to
pulmonary edema. Renal
venous congestion was suspected as the primary cause of AKI, since IVC compression from a
hematoma with IVC injury was observed on CT imaging captured on admission, and renal Doppler ultrasonography demonstrated an intermittent biphasic pattern of renal venous flow. It was finally concluded that renal
venous congestion resulted from IVC compression, since urine output increased remarkably after RRT without additional
diuretics, and follow-up CT and renal Doppler ultrasonography revealed improvements in IVC compression and renal venous flow pattern, respectively. Renal
venous congestion has been often reported to be associated with acute decompensated
heart failure and, to our knowledge, this is the first report to describe
trauma-induced renal
venous congestion.
Trauma patients are at risk for renal
venous congestion due to massive
blood transfusion after recovery from
hemorrhagic shock; therefore, if they develop AKI that cannot be explained by other etiologies, physicians should consider the possibility of
trauma-induced renal
venous congestion and perform renal Doppler ultrasonography.