ESRD Following Complete Abdominal Aortic Occlusion

Introduction: Abdominal aortic occlusion is a rare but serious condition that can lead to significant organ ischemia, including renal failure. While atherosclerosis is a common cause, complete occlusion of the abdominal aorta, especially distal to the celiac artery, is uncommon and poses diagnostic and therapeutic challenges. Prompt recognition and management are crucial to prevent irreversible organ damage. Case Description: A 69-year-old female with a past medical history of hypertension, chronic obstructive pulmonary disease (COPD), coronary artery disease, renal cell carcinoma status post left nephrectomy and chronic kidney disease stage 3 was admitted to the hospital with bradycardia and dizziness. On presentation, her vital signs were: blood pressure 112/57 mmHg, heart rate 60 bpm, respiratory rate 14/min, and temperature 98.8°F. Initial laboratory evaluation revealed severe acute kidney injury with a creatinine level of 11.0 mg/dL (baseline 0.9 mg/dL), an estimated glomerular filtration rate (eGFR) of 3 mL/min and hyperkalemia with a potassium level of 7.0 mmol/L. A computed tomography (CT) scan of the abdomen revealed aortic dilation, prompting further evaluation with CT angiography. This revealed an expanding abdominal aortic aneurysm with complete occlusion of the abdominal aorta just distal to the origin of the celiac artery. Vascular surgery was urgently consulted, and a continuous intravenous heparin infusion was initiated. Due to worsening hyperkalemia and oliguric renal failure, the patient was started on hemodialysis. She was transferred to a tertiary care center for higher-level of care. Her renal function did not recover, and she was declared end-stage renal disease (ESRD) Discussion: Renal ischemia resulting from aortic occlusion can lead to acute kidney injury, which, if prolonged, may progress to end-stage renal disease (ESRD). The kidneys are particularly vulnerable to hypoperfusion due to their high metabolic demand and reliance on a constant blood supply. In this patient, the development of ESRD may have been due to prolonged renal ischemia secondary to compromised perfusion from the aortic blockage. Imaging modalities like CT angiography are vital for diagnosis. Management often involves anticoagulation and surgical interventions, such as aorto-bifemoral bypass, to restore perfusion. However, the prognosis remains guarded, especially in elderly patients with multiple comorbidities.