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Ovarian Hyperstimulation Syndrome is a rare life-threatening capillary leak syndrome in young healthy women associated with in-vitro fertilization. In severe cases, it can cause acute kidney injury causing hypovolemia and oliguria. This is a case of a young healthy female who developed acute kidney injury stage 3 after egg cell harvest for in-vitro fertilization.
A 38-year-old female without known co-morbidities was given GnRH antagonist (Cetrorelix) 0.25 mg and Aromatase inhibitor (Letrozole) 2.5mg for 2 months in preparation for egg cell harvest. 4 days before admission she underwent egg cell harvest. The patient noted abdominal bloatedness and increasing abdominal girth after egg cell harvest. Evaluation with ultrasound revealed enlarged bilateral ovaries measuring 10.3 x 7.7 x 10.6 cm (volume 438ml) right and 11.2 x 9.0 x 9.7cm (volume 438ml) left. Creatinine of 2.40mg/dl on day 4 post egg cell harvest was noted and she was referred to nephrology service.
Abdominal ascites quantified as 2,590ml via ultrasound. Urine output was decreased to 18ml per hour. The patient was hydrated with a normal saline solution of 1ml/kg/hr and given an infusion of albumin 20% 50ml every 8 hours. There was increasing creatinine, abdominal girth, and an increase in the severity of abdominal pain. Paracentesis was done on day 4 of admission draining 2,600ml of tea-colored clear fluid. Resolution of symptoms and increase in urine output was noted post paracentesis.
Ovarian Hyperstimulation Syndrome is a rare but significant cause of severe AKI. Early therapeutic interventions if not instituted properly could lead to mortality. The management of these patients entails hydration and albumin infusion. If massive ascites occur, paracentesis is also indicated.