Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding

Abstract

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.

Keywords: Endoscopic papillectomy; Hemorrhage; Kidney cortex necrosis; Tranexamic acid.

Fig. 1.

Abdominal computed tomography scan revealing a 2-cm round mass (white arrow in A) near the ampulla of Vater, with mild to moderate dilation of the intrahepatic and common bile ducts as well as the pancreatic ducts (B). Both kidneys were normal in size without apparent abnormalities.

Fig. 2.

A 2-cm adenoma-like protruding lesion was found in the ampulla of Vater on endoscopy (A) and endoscopic ultrasound showed an approximately 17-mm well-defined isoechoic homogeneous mass without bile duct or pancreatic duct invasion. A dilated common bile duct is visible (B, C). After mass resection using a snare and the insertion of a biliary plastic stent, no specific complications, such as severe bleeding or perforation, were observed (D)

Fig. 3.

Follow-up abdominal contrast-enhanced computed tomography scan revealing normal-sized kidneys with enhancement of the renal medulla but not the renal cortex (white arrows) consistent with acute renal cortical necrosis (A, B).