title: A SCUBA diver with acute kidney injury.
abstract: An otherwise healthy young man was transferred to our hospital after a diving incident. He had made an uncontrolled ascent from 10 m. On arrival he appeared well. No hypotensive episodes occurred during the transfer. He denied having arthralgias, back pain, dyspnoea or neurological symptoms. Laboratory investigations revealed acutely elevated creatinine (170 µmol/L) and creatine kinase (909 U/L). Radiology was consistent with a focus of pulmonary barotrauma and intrinsic renal disease. Creatine kinase is a marker of arterial gas embolism (AGE). We determined that our patient suffered acute kidney injury as a result of gas embolisation to his renal vasculature from an area of pulmonary barotrauma. Creatinine fell the following day in response to aggressive intravenous fluids. This is the first reported case of acute kidney injury secondary to AGE. Biochemical studies should be part of the routine assessment of patients involved in diving incidents.
authors.affiliation: Department of Medicine, University College Hospital, Galway, Ireland.
authors.forename: Patrick James
authors.initials: PJ
authors.lastname: Gleeson
authors.affiliation: Department of Nephrology, University College Hospital, Galway, Ireland.
authors.forename: Yvelynne
authors.initials: Y
authors.lastname: Kelly
authors.affiliation: Emergency Department, Midland Regional Hospital, Mullingar, Ireland.
authors.forename: Eadaoin
authors.initials: E
authors.lastname: Ni Sheaghdha
authors.affiliation: Department of Nephrology, University College Hospital, Galway, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Lappin
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D000328:Adult; D001469:Barotrauma / Q000150:complications*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D004242:Diving / Q000293:injuries*; D004618:Embolism, Air / Q000150:complications* / Q000209:etiology; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D055370:Lung Injury / Q000150:complications* / Q000209:etiology; D008297:Male; D016896:Treatment Outcome
chemical_list: D003404:Creatinine; D003402:Creatine Kinase