Acute Kidney Injury in a Patient with Aneurysmatic Subarachnoid Haemorrhage: A Case Report
Keywords:
acute kidney injury (AKI), aneurysmatic subarachnoid haemorrhage, uremic coma, renal replacement therapyAbstract
Aneurysmatic SAH (aSAH) is a life-threatening condition, with an incidence of 6–10 cases per 100,000 patients annually. It can present with an intense headache described as "the worst headache of your life", nausea and vomiting, epileptic seizures, and an altered level of consciousness. Sympathetic activation due to complex pathophysiological processes may lead to extracerebral organ injury, including cardiac pathology, neurogenic pulmonary oedema, and acute kidney injury (AKI). The incidence of AKI in a SAH patients ranges from 16.3% to 25%. SAH patients who develop AKI have a poorer outcome and higher mortality. Uremic encephalopathy is a cerebral dysfunction caused by acute kidney injury and the accumulation of uremic toxins, resulting in an impaired level of consciousness and uremic coma. Therefore, AKI may mimic or worsen patients' neurological status. The diagnosis of uremic encephalopathy or coma is established after neurological improvement following dialysis.
References
1. van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124(Pt 2):249-78.
2. Etminan N, Chang HS, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure and smoking prevalence in population: a systematic review and meta-analysis. JAMA Neurol. 2019;76(5):588-597.
3. Eagles ME, Powell MF, Ayling OGS, Tso MK, Macdonald RL. Acute kidney injury after aneurysmal subarachnoid hemorrhage and its effect on patient outcome: an exploratory analysis. J Neurosurg. 2019;133(3):765-772.
4. Hasegawa Y, Uchikawa H, Kajiwara S, Morioka M. Central sympathetic nerve activation in subarachnoid hemorrhage. J Neurochem. 2022;160(1):34-50.
5. Fukuda M, Hirayu N, Nabeta M, Kikuchi J, Morioka M, Fukami K, Takasu O. Factors Associated with the Onset of Acute Kidney Injury Following Subarachnoid Hemorrhage. World Neurosurg. 2024;190:e1093-e1099.
6. Husain-Syed F, Takeuchi T, Neyra JA, Ramírez-Guerrero G, Rosner MH, Ronco C, Tolwani AJ. Acute kidney injury in neurocritical care. Crit Care. 2023;27(1):341.
7. Subah G, Patel R, Nolan B, Fortunato M, Lui A, Uddin A, et al. Acute kidney injury in subarachnoid hemorrhage: Exploring its clinical significance and prognostic implications. J Stroke Cerebrovasc Dis. 2024;33(9):107843.
8. Olano CG, Akram SM, Hashmi MF, et al. Uremic Encephalopathy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
9. Liabeuf S, Pepin M, Franssen CFM, Viggiano D, Carriazo S, Gansevoort RT, et al. Chronic kidney disease and neurological disorders: are uraemic toxins the missing piece of the puzzle? Nephrol Dial Transplant. 2021;37(Suppl 2):ii33-ii44.
10. Parsons AD, Sanscrainte C, Leone A, Griepp DW, Rahme R. Dialysis Disequilibrium Syndrome and Intracranial Pressure Fluctuations in Neurosurgical Patients Undergoing Renal Replacement Therapy: Systematic Review and Pooled Analysis. World Neurosurg. 2023;170:2-6.
11. Evans AR, Zhao X, Ernst GL, Ortiz-Garcia J, Dunn IF, Burke J. Dialysis disequilibrium syndrome in neurosurgery: literature review and illustrative case example. Geroscience. 2024;46(6):5431-5437.
12. Bhandari B, Komanduri S. Dialysis Disequilibrium Syndrome. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
