Gleeson Patrick James, Kelly Yvelynne, Ni Sheaghdha Eadaoin, Lappin David
Department of Medicine, University College Hospital, Galway, Ireland.
Department of Nephrology, University College Hospital, Galway, Ireland.
BMJ Case Rep. 2015 May 6;2015:bcr2014206345. doi: 10.1136/bcr-2014-206345.
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.
一名原本健康的年轻男子在一次潜水事故后被转送至我院。他从10米深处进行了无控制的上升。到达时他看起来状况良好。转运过程中未发生低血压发作。他否认有关节痛、背痛、呼吸困难或神经症状。实验室检查显示肌酐（170微摩尔/升）和肌酸激酶（909单位/升）急性升高。放射学检查结果与肺气压伤病灶和原发性肾病相符。肌酸激酶是动脉气体栓塞（AGE）的标志物。我们确定患者因肺气压伤区域的气体栓塞至其肾血管系统而遭受急性肾损伤。次日，肌酐因积极静脉补液而下降。这是首例报道的继发于AGE的急性肾损伤病例。生化研究应成为潜水事故相关患者常规评估的一部分。
