Bladder Decompression as a Non-Renal Replacement Intervention for Acute Renal Failure and Severe Hyperkalemia with EKG Changes in Obstructive Nephropathy

Abstract

Kylie Oppegaard, Supreet Kaur, Avais Masud, Sowmya Dandu, Joseph Perez, Amolika Gupta, Zeinab Abdulrahman, Kyrillos Rezkalla, Hira Akhlaq, Prit Paul Singh, Arif Asif, Tushar J Vachharajani and Sushi K Mehandru

Renal replacement therapy is indicated in cases of acute renal failure and hyperkalemia with EKG changes regardless of etiology. In this presentation, we report seven cases of obstructive nephropathy resulting in acute renal failure and hyperkalemia with EKG changes, successfully managed through bladder decompression using a foley catheter and a potassium-lowering protocol. We aim to highlight the clinical utility of bladder decompression as a promising intervention for management of acute renal failure and hyperkalemia causing EKG changes in patients with obstructive nephropathy. This is the first case report in the literature to demonstrate such to the best of our knowledge. Existing literature has shown the absence of immediate relief in obstructive nephropathy can result in permanent renal damage, influencing clinicians to initiate renal replacement therapy. Our team utilized bladder decompression during a typical 2-hour window that would take to initiate renal replacement therapy to actively reduce serum potassium levels, reverse EKG abnormalities, and improve renal function. By presenting these cases, we hope to provide clinicians with a broader perspective for the management of hyperkalemia and acute renal failure in obstructive nephropathy without the need of renal replacement therapy.

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