2019 Volume 26 Issue 3 Pages 181-185
There are few reports concerning acute kidney injury after segmental inferior vena cava (IVC) resection. Therefore, we would like to report a case of acute kidney injury due to outflow interruption in the renal vein after segmental IVC resection. Pancreaticoduodenectomy was performed in a 70-year-old woman. Since a tumor had infiltrated the anterior surface of the IVC at the junction of the renal vein, segmental IVC resection was also performed. After the operation, she had decreased urine output despite fluid therapy as well as increased Cr level. Contrast-enhanced CT revealed occlusion of the IVC involving the renal confluence and congestion of the right kidney, which we diagnosed as acute kidney injury due to outflow interruption in the renal vein. We began volume loading and administration of noradrenaline and vasopressin to increase renal perfusion pressure and glomerular filtration rate. Increases in mean blood pressure of 120% and beyond resulted in an increase in urine volume and decrease in Cr level. Subsequent contrast-enhanced CT showed development of collateral circulation and reduction in swelling of the right kidney. Her clinical course afterwards was uneventful. If a decrease in urine volume does not respond to fluid therapy after pancreaticoduodenectomy with segmental IVC resection, the possibility of outflow interruption in the renal vein should be considered.
