Acute kidney injury due to decompression illness

Abstract

Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. We report the first case of acute kidney injury in a 27-year-old diver following three rapid ascents. He presented with transient neurological symptoms and abdominal pain followed by rapidly progressive acute kidney injury (creatinine peak 1210 µmol/L) due to arterial air emboli. He received supportive care and 100% oxygen followed by hyperbaric therapy and recovered fully. Arterial air emboli caused by rapid decompression can affect multiple organs including the kidneys. Early transfer to a hyperbaric unit is important as complications may present delayed.

Keywords: acute kidney injury; arterial air embolism; decompression illness; pulmonary barotrauma.

Fig. 1.

Tc-99m-MAG3 scan performed on Day 4 post-diving accident: the first two panels show the perfusion of both kidneys over 32 s (2 s/frame) and the third panel shows tracer concentration (reflecting renal function) over 16 min (2 min/frame). The top graph (renogram) shows normal perfusion of the left and right kidney and the bottom graph illustrates tracer retention in the left and right kidney in keeping with acute tubular necrosis.

Fig. 2.

Time line of creatinine (µmol/L) and clinical symptoms.