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Case Reports
. 2014 Sep 1:8:289.
doi: 10.1186/1752-1947-8-289.

Oliguric acute kidney injury as a main symptom of bradycardia and arteriosclerosis resolved by pacemaker implantation: a case report

Rainer U Pliquett  1 , Daniel Radler, Alexander Tamm, Daniel Greinert, Robin Greinert, Matthias Girndt
Affiliations
Case Reports

Oliguric acute kidney injury as a main symptom of bradycardia and arteriosclerosis resolved by pacemaker implantation: a case report

Rainer U Pliquett et al. J Med Case Rep. .

Abstract

Introduction: Cardiovascular comorbidities regularly determine renal function. We report a case of acute kidney injury (Acute Kidney Injury Network stage 3) due to an intermittent third-degree atrioventricular block, which had not been diagnosed before.

Case presentation: A 76-year-old Caucasian man with liver cirrhosis due to non-alcoholic fatty liver disease, and type-2 diabetes was cognitively impaired and had reduced vigilance presumably caused by hepatic encephalopathy and/or Alzheimer dementia. Within 2 years, two hospitalizations occurred for syncope attributed to orthostatic failure and hypovolemia. During the last hospitalization, oliguric acute kidney injury occurred. Sonography ruled out a post-renal cause. His renal resistive index was 1.0; his heart rate was below 50 beats per minute. After cessation of beta-blocker therapy, Holter electrocardiogram showed a new intermittent third-degree atrioventricular block with pauses for less than 3 seconds. Pacemaker insertion resolved his acute kidney injury, despite resumption of beta-blocker therapy. During four months of follow-up, syncope has not occurred, and vigilance was stable. However, his renal resistive index of 1.0 remained.

Conclusions: Here, typical neurologic symptoms of bradycardia were misclassified. Diagnostic work-up of oliguric acute kidney injury revealed intermittent third-degree heart block. The pathomechanism of acute kidney injury relates to relevant bradycardia and increased vascular stiffness attenuating arterial diastolic renal blood flow.

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Figures

Figure 1
Figure 1
Ultrasound images obtained during index hospitalization showing nephrosclerotic kidneys with centralized arterial perfusion.
Figure 2
Figure 2
Holter electrocardiogram reading of index hospitalization (paper speed 25mm/s) shows sinus rhythm with an average heart rate of 45 beats per minute, intermittent third-degree heart block, a pre-existing first-degree heart block and right-bundle branch block. Arrowheads point to P waves. RR interval (bold upper line) is the same as the PP interval (bold lower line) indicating 1 to 1 conduction.
Figure 3
Figure 3
Follow-up kidney Doppler sonography examination at 4 months after discharge (upper panel: left side, lower panel: right side): resistive index of 1.0 on both sides.
See this image and copyright information in PMC

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