Cardiovascular Arrest Due to Postrenal Kidney Injury

A 77-year-old man with increasing listlessness and unwanted weight loss visited a radiologist’s office located on the premises of the hospital for elective cranial computed tomography (without contrast medium). Following the examination he suddenly collapsed in the foyer. The emergency team encountered a comatose patient (GCS 3) with an initially still palpable bradycardic pulse. Subsequent disappearance of the pulse was followed by cardiopulmonary resuscitation according to the guidelines, with the return of spontaneous circulation after 2 minutes. Electrocardiography showed a bradycardic ectopic atrial rhythm with grade I AV block and complete right bundle block. In the presence of severe metabolic acidosis and marked hyperkalemia (8.8 mmol/L), calcium gluconate and insulin/glucose were given. Physical examination revealed an abdominal swelling. Emergency sonography merely identified a cystic mass of unclear nature, but computed tomography (Figures 1 and 2) showed the cause of this hyperkalemia-induced cardiovascular arrest: postrenal kidney injury owing to massive prostatomegaly-related urinary retention with bilateral hydronephrosis. The patient survived the event, and after a long stay in intensive care he was transferred to a specialist center for weaning.

Figure

Computed tomography (CT) with contrast medium in the soft tissue window

Dr. med. Juri Mattern, Dr. med. Marc-Sebastian Baier, Dr. med. Jürgen Majolk, Interdisziplinäre Zentrale Aufnahme, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Mattern J, Baier MS, Majolk J: Cardiovascular arrest due to postrenal kidney injury. Dtsch Arztebl Int 2024; 121: 181. DOI: 10.3238/arztebl.m2023.0105

By kind permission of Radiological Center Speyer MVZ GmbH.