Severe acute kidney injury after near-drowning in a healthy adult: A case report.

RATIONALE: Acute kidney injury (AKI) is an uncommon but serious complication of near-drowning, and its underlying mechanisms remain poorly defined. Existing evidence suggests a multifactorial process, yet reports with integrated clinical and pathological evaluation are scarce. PATIENT CONCERNS: A previously healthy man in his thirties presented with progressive oliguria and elevated serum creatinine 2 days after a freshwater near-drowning incident. DIAGNOSES: AKI secondary to near-drowning. INTERVENTIONS: The patient received individualized fluid management, empirical antibiotics, and intermittent hemodialysis. A renal biopsy was performed to clarify the underlying mechanism. OUTCOMES: Renal histology confirmed acute tubular injury. The patient underwent 7 dialysis sessions. Urine output and renal function gradually recovered, and he was discharged on hospital day 11. Follow-up after 1 month showed complete normalization of renal function. LESSONS: AKI following near-drowning may be multifactorial, with ischemia-reperfusion injury being the primary contributor. In ambiguous cases, renal biopsy can provide valuable histological evidence to support diagnosis and guide therapy. Early recognition and tailored supportive strategies are essential for renal recovery.