Acute Kidney Injury in A Female Patient with Pulmonary Embolism (Clinical Case)

The article presents a clinical case of high-risk pulmonary embolism (PE) in a 74-year-old patient complicated by the development of acute kidney injury (AKI). The article discusses the manifestations, clinical, diagnostic, and therapeutic aspects of managing patients with PE, including the use of thrombolysis and anticoagulant therapy. Clinical manifestations of the disease are described, including severe shortness of breath, weakness, and swelling of the lower extremities. The course of PE was complicated by the development of AKI, established by oliguria and high serum creatinine levels. The data from laboratory and instrumental studies are presented, demonstrating the dynamics of recovery of kidney function after treatment. The possible role of congenital malformation (agenesis) of left kidney in the patient as a condition of predisposition to AKI is mentioned. The basic information about the pathophysiological mechanisms of AKI in PE is presented. The effect of acute right ventricular failure, which leads to increased central venous pressure, passive renal hyperemia, increased interstitial pressure, and renal interstitial edema, is discussed. In the development of AKI, a decrease in cardiac output is also distinguished, followed by hypoperfusion of the renal parenchyma. It is believed that concomitant diseases such as diabetes mellitus, arterial hypertension, and chronic kidney disease are both risk factors for the development of AKI, predispose to kidney damage under severe hemodynamic stress, and factors that exacerbate renal dysfunction with hypoperfusion and congestive nephropathy. Special attention is paid to the effect of AKI on the prognosis of PE. The authors conclude that an integrated approach is needed to assess the condition of patients with PE, monitor renal function, and develop individual therapeutic strategies to minimize the risks of kidney damage. The article highlights the importance of timely intervention and differentiated treatment tactics for patients with PE and concomitant AKI.

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