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Severe acute kidney injury due to violent sadomasochistic play
  1. Fabian Echterdiek,
  2. Daniel Kitterer,
  3. Vedat Schwenger,
  4. Jörg Latus
  1. Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
  1. Correspondence to Dr Fabian Echterdiek, f.echterdiek{at}


Bondage and discipline, dominance and submission, sadism and masochism (BDSM) refers to a variety of primarily erotic practices. Although safety is crucial for most BDSM practitioners, there are violent forms that may cause serious injury. We present the case of 61-year-old man with no history of chronic kidney disease who developed severe acute anuric kidney injury following violent BDSM play. He had been strapped tightly onto a wooden spanking bench and then received approximately 1000 vigorous hits onto his bare buttocks and thighs. Subsequently, he developed haematuria and became anuric. Laboratory testing revealed strongly elevated serum creatinine levels. Kidney biopsy was unremarkable except mild tubulointerstitial damage. Urinary production increased spontaneously again after 4 days, and serum creatinine normalised over the course of 4 weeks. We believe that a combination of intermittent abdominal compartment syndrome and blunt kidney trauma may have been responsible for this severe acute kidney injury.

  • acute renal failure
  • haematuria
  • sexual health

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  • Contributors All four authors made individual and valuable contributions to this article. FE, DK, VS, JL: were involved in the conception and design of this case report. FE: acquired, analysed and interpreted the data. FE, JL: drafted the article. DK, VS: revised it critically for important intellectual content. All four authors gave final approval of the version published. All four authors consented to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.