Severe acute kidney injury associated with immersion into seawater

Abstract

Near drowning is an important, but rarely reported precipitant of acute kidney injury (AKI). The underlying pathophysiology is thought to be ischaemic kidney injury, but diagnostic uncertainty has arisen due to reports of isolated AKI in the absence of ischaemic damage to other organs. Here we describe a case of immersion into seawater resulting in near drowning and severe AKI. Our case highlights the need for assessment of kidney function in this situation. Based on the clinical presentation, we propose that ischaemic injury does indeed occur, and we make suggestions on the management of such patients in the absence of histopathological information obtained from renal biopsy.

Keywords

• acute kidney injury
• acute kidney tubular necrosis
• near drowning
• renal circulation