Hemolysis and acute kidney failure.
Deposits of iron and hemosiderosis in the kidney have been observed in diseases with intravascular hemolysis, including paroxysmal nocturnal hemoglobinuria, and valvular heart diseases and prosthetic heart valve implants. However, the decrease in kidney function associated with hemolysis caused by cardiac valvular disease or prostheses is less well recognized. We present a case of intravascular hemolysis after repair and banding of the mitral valve that resulted in massive renal tubular deposition of hemosiderin with decreased kidney function. We discuss the pathophysiologic process of both acute and chronic tubular injury from heme and heme proteins, including injury to organelles resulting in autophagic vacuoles containing damaged organelles, such as mitochondria. We conclude that tubular injury resulting from heme proteins should be considered as a cause of decreased kidney function in all patients with a cardiac valvular disease or prosthesis.
Qian
Qi
Q
Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Nath
Karl A
KA
Wu
Yiming
Y
Daoud
Tarek M
TM
Sethi
Sanjeev
S
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006461:Hemolysis; D006485:Hemosiderin / Q000378:metabolism; D006486:Hemosiderosis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006435:Renal Dialysis / Q000379:methods
D006485:Hemosiderin