Dark Urine After Nonfatal Drowning: Rhabdomyolysis-Associated Acute Kidney Injury and Freshwater Aspiration Pneumonia

Nonfatal drowning is managed primarily as a respiratory emergency, but clinically important kidney injury may be overlooked, particularly with delayed presentation. A previously healthy 53-y-old man fell into a freshwater pond that may have been contaminated by wastewater, struggled for ∼30 to 60 min, aspirated water, and presented 2 to 3 d later with fever, dyspnea, oliguria, and dark brown urine. Respiratory testing identified Aeromonas hydrophila complex and Escherichia coli , supporting drowning-associated pneumonia after freshwater aspiration. Serum creatinine was 986 μmol·L –1 (11.2 mg·dL –1 ), creatine kinase 79,765 U·L –1 , and serum myoglobin 8630 ng·mL –1 ; urine was heme positive with few red blood cells. The patient had Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury requiring continuous renal replacement therapy followed by intermittent hemodialysis. Dialysis ended on Day 25, and kidney function normalized by Day 94. Delayed presentation, prolonged struggle, hypoxemia, oliguria, and dark urine should prompt targeted renal assessment after drowning. When drowning-associated pneumonia is evident clinically, respiratory sampling should guide antimicrobial treatment; renal replacement therapy should be used for standard severe acute kidney injury indications rather than myoglobin removal alone.