Acute Renal Failure During a Trial of Spinal Cord Stimulation: Theories as to a Possible Connection

Objective: This is the first case describing an episode of acute renal failure occurring during a spinal cord stimulation trial.Clinical Presentation: A 48-year-old male with a history of hypertension and 3prior failed spine surgeries underwent a trial of spinal cord stimulation for uncontrolled bilateral lower extremity neuropathic pain. Two days after the placement ofthe percutaneous stimulator lead the patient returned complaining of 3 syncopalepisodes. He was found to be hypotensive and in acute renal failure with a creatinine of 8.1 and a BUN of 83.Intervention: The stimulator lead was immediately removed. The patient was admitted to the intensive care unit and responded promptly to rehydration and placement of a urinary catheter. His renal and urological work-ups revealed no significant abnormalities.Conclusion: The development of the episode of acute renal failure may havebeen influenced by the secondary effects of spinal cord stimulation. Since acute renal failure has never been associated with the use of spinal cord stimulation, thissingular example does not by itself demonstrate a relationship. However, if futureepisodes are seen, a link between the 2 events could be drawn. For now, it is notclear if the development of this patient’s acute renal failure could, in part, be attributed to the use of the spinal cord stimulator or if it was merely coincidental innature. We do feel it is useful for the clinician to understand the pathophysiologicchanges associated with spinal cord stimulation and to see how, at least in theory,there could be a connection.Key words: acute renal failure, spinal cord stimulation