Журнал клинических случаев

A Case of Acute Renal Failure with Hemolysis Caused by Impella

Abstract

Takigami M, Yanishi K, Nakanishi N and Matoba S

Background: Some recent guidelines do not recommend the routine use of intra-aortic balloon pumping for patients with cardiogenic shock. Therefore, the use of Impella will further increase as an alternative to intra-aortic balloon pumping for many patients with cardiogenic shock and who are considered to be a high-risk group for percutaneous coronary intervention. However, some serious complications, such as renal failure and hemolysis, have been reported after the use of Impella. We here describe a rare case of acute renal failure with hemolysis caused by Impella.

Case presentation: A 66-year-old male patient presented with cardiogenic shock caused by ST-segment elevation myocardial infarction. We performed early revascularization supported by Impella because his vitals were unstable. The color of his urine turned blackish brown a few hours later, and he developed oliguria. On echocardiography, we found the pigtail catheter tip of Impella to be on the basal posterior wall; however, the device monitor showed no abnormal signs. Laboratory examination showed increased lactate dehydrogenase level, and we suspected acute renal failure with hemolysis caused by Impella. Therefore, we decided to remove the Impella device. Soon thereafter, the color of the patient’s urine became clear and his lactate dehydrogenase level improved. He received continuous renal replacement therapy 4 times, and his urinary output gradually increased, and his renal function eventually recovered completely.

Conclusion: We suspected that the main factor worsening the renal function of our patient was hemolysis caused by Impella. A routine echocardiography is useful for detection an improper location of Impella.