Hope for the best prepare for the worst: acute kidney disease and catastrophic comorbidities (a case report).

Abstract

It is evident that Acute Kidney Injury (AKI) is an independent risk factor for both the survival of patients and their kidneys. Here, we present a case of oliguric AKI secondary to blunt trauma-induced crush syndrome complicated with severe sepsis in which the patient had a complete recovery of kidney functions after 3 months of dialysis dependency. A 40-year-old male construction worker had a severe episode of work accident. He had fallen into the stream from a height of 6 meters and the concrete pillars of the bridge fell over him. He had an iliac artery injury, crush-related acute kidney failure, a ruptured bladder, multiple fractures in the lumbar vertebral spinous and transverse processes, bilateral pelvic rami, acetabulum, and bilateral iliac wings. Despite 3 months of dialysis dependency with multiple episodes of sepsis and nephrotoxic antibiotic applications, fortunately, recovery of kidney functions (creatinine clearance >20 mL/min) was achieved. The creatinine clearance of the patient was calculated as 78 mL/min one year after discharge from the hospital. It is well-known that severe trauma leading to severe sepsis and severe AKI has catastrophic effects on the survival of patients. In addition, nephrotoxic antibiotics and contrast media had to be given to our patient, which resulted in further injury. A multidisciplinary (including nursery care) approach, early and proper treatment of sepsis, pulmonary rehabilitation, enteral/parenteral nutritional support, and appropriate timing, prescription, and dose of dialysis are fundamental factors playing a major role in the recovery of prolonged AKI as in our patient.