Case Study on Blunt Injury induced AKI

Janet Vasanthi1, Esthar Rani2

1Nursing Incharge, Kauvery Hospital, Tennur, Trichy

2Nursing Superintendent, Kauvery Hospital, Tennur, Trichy

Abstract

Acute Kidney Injury (AKI) refers to a sudden decline in kidney function resulting in the accumulation of metabolic waste products. Trauma-related AKI is relatively rare but can occur due to factors such as rhabdomyolysis, hypovolemia, or direct renal contusion. Blunt trauma, especially to the abdomen or lower back, can compromise renal perfusion or cause acute tubular necrosis. This case highlights the clinical course of trauma-induced AKI and underlines the pivotal role of nurses in early detection and multidisciplinary management.

Modifiable risk factor:

  • Volume depletion: Due to vomiting, diarrhea, bleeding, or inadequate fluid intake.
  • Use of nephrotoxic drugs: NSAIDs, Aminoglycosides, Contrast agents (used in imaging), Some antivirals and chemotherapy drugs
  • Sepsis/Infections: Can lead to systemic inflammation and low blood pressure
  • Hypotension (low blood pressure): Reduces kidney perfusion
  • Obstruction of urinary tract: Can be managed with early detection
  • Rhabdomyolysis: Often due to trauma, seizures, or drug use; preventable/treatable early.
  • Major surgery or trauma: Risk can be reduced with perioperative care.
  • Exposure to toxins: Industrial chemicals, herbal remedies, etc.
  • Uncontrolled diabetes or hypertension: Can worsen or precipitate AKI.
  • Poor hospital practices: Lack of monitoring, fluid mismanagement, etc.

Non-Modifiable risk factor:

  • Age: Elderly patients have reduced kidney reserve
  • Pre-existing Chronic kidney Disease (CKD): Increases susceptibility to further kidney injury.
  • Diabetes Mellitus: A major contributor to kidney dysfunction.
  • Hypertension: Long-standing high blood pressure can predispose kidneys to damage.
  • Liver Disease (e.g., cirrhosis): Increases risk of hepatorenal syndrome.
  • Genetic predisposition: Certain genetic mutations can affect kidney function
  • Male Gender: Males are slightly more prone in some studies.

Assault Induced AKI

Acute Kidney Injury (AKI) is a significant clinical condition that can occur due to multiple etiologies, including trauma. Blunt force assault, though less frequently documented, can lead to AKI via mechanisms such as rhabdomyolysis, hypovolemia, or direct renal injury. This article presents a case of AKI following physical assault and emphasizes the role of early diagnosis, renal support, and comprehensive nursing care.

Case History

A 24-year-old male was admitted with an alleged history of blunt trauma due to physical assault. Initially treated at an outside hospital, he presented to the ER with complaints of decreased urine output, bilateral renal colicky pain, vomiting, and constipation. On evaluation, he was found to have severe azotemia with serum creatinine of 10.5 mg/dL and blood urea of 141 mg/dL, along with clinical anuria. In view of his worsening renal parameters, he was initiated on RRT via a right internal jugular vein hemodialysis catheter. The patient showed symptomatic improvement with consecutive hemodialysis sessions, and his urine output became adequate.

However, on May 24, 2025, the patient developed a sudden onset of blurred vision, headache, vomiting, and focal seizures. A CT brain scan revealed white matter hypo density in bilateral cerebellar and occipital cortex, suggestive of posterior reversible encephalopathy syndrome (PRES). Due to worsening sensorium and the risk of aspiration, he was emergently intubated. MRI brain further showed T2/FLAIR hyper intensities in bilateral fronto-parietal, parieto-occipital, and cerebellar regions with patchy diffusion restriction, supporting the diagnosis of PRES. He was managed with antiepileptic medications and other supportive measures.

Over the next few days, the patient’s neurological status improved significantly, and he was successfully extubated on May 27, 2025. His renal function also showed marked improvement, with serum creatinine levels returning to 1 mg/dL. In view of the improvement in renal function, the patient was advised to discontinue hemodialysis and to monitor his blood pressure regularly at home. He remained hemodynamically stable and was discharged in a clinically stable condition with advice for follow-up.

Nursing Care

Skilled nursing care for assault induced Acute Kidney Injury (AKI) focuses on managing the immediate consequences of the injury and supporting the kidneys in their recovery. This includes monitoring vitals, fluid balance, electrolyte levels and potential complications like infections.

Monitoring and Assessment:

  1. Monitored Renal Function and Vital Signs

– Nurses closely observed urine output, blood pressure, and serum creatinine levels to detect any signs of worsening renal status.

  1. Assisted with Hemodialysis Preparation and Aftercare

– The nursing team prepared the patient for dialysis by ensuring catheter patency, maintaining aseptic technique and monitoring the patient throughout each session.

  1. Identified and Responded to Neurological Changes

– When the patient showed signs of PRES (blurred vision, headache, and seizures), nurses promptly notified the medical team and initiated seizure precautions.

  1. Administered Medications as Prescribed

– Nurses ensured timely administration of antiepileptic drugs, antihypertensives, and other supportive medications.

  1. Provided Continuous Monitoring in ICU

– During the patient’s critical phase, nurses performed hourly neurological assessments, maintained airway patency post-extubation, and supported vital organ function.

  1. Educated Patient and Family

– Before discharge, nurses provided education regarding renal health, the importance of blood pressure monitoring and signs of potential complications to watch for.

Conclusion

By providing comprehensive nursing care including monitoring medication management, fluid balance, infection prevention and education skilled nurses play a vital role in supporting patients with assault induced AKI during their recovery.

References

  • Perkins ZB, Greenhalgh R, Ter Avest E, Aziz S, Whitehouse A, Read S, Foster L, Chege F, Henry C, Carden R, Kocierz L, Davies G, Hurst T, Lendrum R, Thomas SH, Lockey DJ, Christian MD.
  • Al-Thani H, Ramzee AF, Asim M, El-Menyar A.J Surg Res. 2023 Apr;284:193-203. doi: 10.1016/j.jss.2022.12.001. Epub 2022 Dec 29.
  • avier Enrique Rincon MD, Rohit Kiran Rasane MBBS MS, Ricardo Alejandro Fonseca MD, Jose Alejandro Aldana MD, Hussain Afzal MD, Christina Xinyue Zhang MD, Melissa Canas MD, Esha Ghosh MS, Mark Houston Hoofnagle MD PhD, Grant Vincent Bochicchio MD, FACS
Kauvery Hospital