A Butterfly Effect in Subarachnoid Hemorrhage: Autograft Healing and Renal Vulnerability After Decompressive Craniectomy

Subarachnoid hemorrhage (SAH) is a neurological disease that has a complex pathogenesis resulting from blood flow into the subarachnoid space. It is associated with a high rate of morbidity and mortality and is caused due to traumatic and non-traumatic factors. Although SAH primarily affects brain tissue and leads to neurological symptoms, it is increasingly recognized that distant organs may also be involved. Among these non-neurological complications, Acute Kidney Injury (AKI) stands out as a frequent and clinically significant event. In cases of refractory intracranial hypertension, Decompressive Craniectomy (DC) is a surgical method often performed to diminish intracranial pressure. However, this surgical intervention imposes a secondary systemic burden that may heighten renal vulnerability due to the subsequent physiological demands of autograft preservation and healing. Based on this framework, the present review summarizes the pathophysiological mechanisms connecting SAH, autograft healing, and AKI. Available evidence suggests that AKI is not only a result of a serious condition but also a relevant factor influencing disease progression and prognosis. Moreover, this review highlights key clinical risk factors and discusses the prognostic implications of renal dysfunction in patients with SAH.