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DOI: 10.1055/s-0039-1694064
Heme-Pigment Induced Acute Kidney Injury after Cavernous Hemangioma Ablation
Publikationsverlauf
Publikationsdatum:
19. August 2019 (online)
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Cavernous hemangiomas are the most common benign liver mass, occurring with up to 7.3% incidence.[1] Giant cavernous hemangiomas—defined as those exceeding 5 cm in diameter—can stretch the liver capsule and prompt abdominal pain in approximately 40% of patients.[2] Radiofrequency ablation (RFA) is employed to treat symptomatic cavernous hemangiomas, and has shown superior effectiveness at alleviating pain—as well as shorter procedure time and reduced blood loss—in comparison to traditional open surgical resection.[3] Acute kidney injury (AKI) is a rare complication of RFA of giant cavernous hemangiomas. This complication, which is due to heme-pigment released in the setting of massive red blood cell (RBC) hemolysis during the procedure, is uncommon, having been described in only a few cases in the literature.[4] [5] Herein, we present an illustrative case of AKI following RFA of a giant cavernous hemangioma requiring hospitalization and aggressive intravenous (IV) hydration, and we discuss risk factors, diagnostic criteria, avoidance strategies, and management approaches for this uncommon adverse event.
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References
- 1 Bailey J, Di Carlo S, Blackwell J, Gomez D. Same day arterial embolisation followed by hepatic resection for treatment of giant haemangioma. BMJ Case Rep 2016 2016. Doi: 10.1136/bcr-2015-213259
- 2 Di Carlo I, Koshy R, Al Mudares S, Ardiri A, Bertino G, Toro A. Giant cavernous liver hemangiomas: is it the time to change the size categories?. Hepatobiliary Pancreat Dis Int 2016; 15 (01) 21-29
- 3 Gao J, Fan RF, Yang JY. , et al. Radiofrequency ablation for hepatic hemangiomas: a consensus from a Chinese panel of experts. World J Gastroenterol 2017; 23 (39) 7077-7086
- 4 van Tilborg AAJM, Dresselaars HF, Scheffer HJ. , et al. RF ablation of giant hemangiomas inducing acute renal failure: a report of two cases. Cardiovasc Intervent Radiol 2016; 39 (11) 1644-1648
- 5 Gao J, Ke S, Ding XM, Zhou YM, Qian XJ, Sun WB. Radiofrequency ablation for large hepatic hemangiomas: initial experience and lessons. Surgery 2013; 153 (01) 78-85
- 6 Tsui SL, Lee AKS, Lui SK, Poon RT-P, Fan ST. Acute intraoperative hemolysis and hemoglobinuria during radiofrequency ablation of hepatocellular carcinoma. Hepatogastroenterology 2003; 50 (50) 526-529
- 7 Li H, Li B, Wei Y, Liu F. Hemolysis as a complication of radiofrequency ablation for hepatocellular carcinoma must be paid more attention. Dig Dis Sci 2011; 56 (11) 3391-3392
- 8 Deuel JW, Schaer CA, Boretti FS. , et al. Hemoglobinuria-related acute kidney injury is driven by intrarenal oxidative reactions triggering a heme toxicity response. Cell Death Dis 2016; 7: e2064
- 9 Heyman SN, Rosen S, Fuchs S, Epstein FH, Brezis M. Myoglobinuric acute renal failure in the rat: a role for medullary hypoperfusion, hypoxia, and tubular obstruction. J Am Soc Nephrol 1996; 7 (07) 1066-1074
- 10 Giuliani KTK, Kassianos AJ, Healy H, Gois PHF. Pigment nephropathy: novel insights into inflammasome-mediated pathogenesis. Int J Mol Sci 2019; 20 (08) E1997
- 11 Zou H, Yan J, Wu YX. , et al. [The new technology of enhanced radiofrequency ablation is safe and effective for treating giant hepatic hemangioma]. Zhonghua Gan Zang Bing Za Zhi 2012; 20 (04) 261-265
- 12 van Tilborg AA, Nielsen K, Scheffer HJ. , et al. Bipolar radiofrequency ablation for symptomatic giant (>10 cm) hepatic cavernous haemangiomas: initial clinical experience. Clin Radiol 2013; 68 (01) e9-e14