Navigating the Challenges of Managing Acute Kidney Injury in a Sickle Cell Anaemic Adolescent Boy in a Resource-poor Setting - A Case Report

Managing Acute Kidney Injury (AKI) in a patient with Sickle Cell Anaemia (SCA) can be challenging, particularly when the patient is haemodynamically unstable and peritoneal dialysis is not feasible. We report the case of a 17-year-old male with Homozygous SCA (HbSS), diagnosed at age 2years, who presented with AKI and hypertensive emergency following Graham’s patch repair for a perforated duodenal ulcer, likely due to chronic NSAID use. By postoperative day 5, he developed facial and pedal oedema, oliguria, elevated blood pressure (up to 190/140 mmHg), and a rise in serum creatinine (644.4 µmol/L), urea (26.7 mmol/L), and potassium (6.25 mmol/L). A diagnosis of AKI on a background of sickle cell nephropathy was made. Given the haemodynamic concerns, haemodialysis was initiated cautiously. Measures taken included: (1) priming of dialysis machine and bloodlines with freshly donated genotype-AA blood, (2) intra-dialysis transfusion, (3) limiting the first dialysis session to 2 hours, and (4) ultrafiltration volume based on pre-AKI and current weight. The patient tolerated three sessions of haemodialysis on alternate days. He experienced remarkable clinical improvement, with a stable blood pressure of 125/70 mmHg, a reduced serum creatinine level of 163.7 µmol/L, and an improved urine output of 3.1 mL/kg/hr. He was discharged on antihypertensives and scheduled for outpatient follow-up. This case highlights the feasibility and safety of carefully monitored haemodialysis in haemodynamically unstable SCA patients with AKI, even in resource-limited settings.