Continuous Renal Replacement Therapy with oXiris® Membrane in Severe Ebstein-Barr Virus-Mediated Hemophagocytic Lymphohistiocytosis: A Case Report

2020 ◽  
pp. 1-4
Author(s):  
Karla N. Samman ◽  
Hussein Baalbaki ◽  
Josée Bouchard ◽  
Martin Albert
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Inflammatory Markers ◽  
Blood Purification ◽  
Cytokine Storm ◽  
Barr Virus ◽  
Ebstein Barr Virus ◽  
Life Threatening

Hemophagocytic lymphohistiocytosis (HLH), a life-threatening disease with uncontrolled immune activation and inflammatory reaction, often leads to a deadly cytokine storm. In severe Ebstein-Barr virus-triggered HLH receiving standard immunosuppression, continuous renal replacement therapy (CRRT) with oXiris<sup>®</sup> blood purification membrane resulted in a timely reduction of inflammatory markers and discontinuation of vasopressors. To our knowledge, this is the first report of successful use of the oXiris<sup>®</sup> membrane in HLH.

scholarly journals Continuous renal replacement therapy rescued life-threatening capillary leak syndrome in an extremely-low-birth-weight premature: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Li-Fen Yang ◽  
Jia-Chang Ding ◽  
Ling-Ping Zhu ◽  
Li-Xia Li ◽  
Meng-Qi Duan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Renal Replacement Therapy ◽  
Low Birth Weight ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Therapeutic Option ◽  
Capillary Leak Syndrome ◽  
Extremely Low Birth Weight ◽  
Capillary Leak ◽  
Life Threatening

Abstract Background Capillary leak syndrome (CLS) is a rare disease characterized by profound vascular leakage and presents as a classic triad of hypotension, hypoalbuminemia and hemoconcentration. Severe CLS is mostly induced by sepsis and generally life-threatening in newborns, especially in premature infants. Continuous renal replacement therapy (CRRT) plays an important role of supportive treatment for severe CLS. Unfortunately, CRRT in preterm infants has rarely been well defined. Case presentation We report the case of a 11-day-old girl with CLS caused by sepsis, who was delivered by spontaneous vaginal delivery (SVD) at gestational age of 25 weeks and 4 days, and a birth weight of 0.89 Kilograms(kg). The infant received powerful management consisting of united antibiotics, mechanical ventilation, intravenous albumin and hydroxyethyl starch infusion, vasoactive agents, small doses of glucocorticoids and other supportive treatments. However, the condition rapidly worsened with systemic edema, hypotension, pulmonary exudation, hypoxemia and anuria in about 40 h. Finally, we made great efforts to perform CRRT for her. Fortunately, the condition improved after 82 h’ CRRT, and the newborn was rescued and gradually recovered. Conclusion CRRT is an effective rescue therapeutic option for severe CLS and can be successfully applied even in extremely-low-birth-weight premature.

scholarly journals Systemic anticoagulation during continuous renal replacement therapy – practical aspects

2019 ◽  
Author(s):  
Dariusz Onichimowski ◽  
Joanna Maria Wolska ◽  
Radosław Borysiuk ◽  
Marcin Mieszkowski ◽  
Zuzanna Stępień ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Therapy ◽  
Blood Purification ◽  
Routine Practice ◽  
Research Papers ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Systemic Anticoagulation

Introduction: Extracorporeal blood purification techniques have become a well-established part of routine practice in intensive therapy units. Ensuring appropriate anticoagulation to prevent the clotting of the circuit is the major concern while applying these techniques. Aim: The aim of this paper is to present methods of systemic anticoagulation which are currently used in continuous extracorporeal blood purification techniques. Ma t e r i a l and me thods : This work is based on the available literature and the experience of the authors. Re sul t s and di s cus s ion: The prevention of clotting in the extracorporeal circuit may be achieved through regional or systemic anticoagulation. Systemic anticoagulation is usually achieved by administration of unfractionated heparin. The most common complications include bleeding; additionally, there is a risk of type II thrombocytopenia occurring. Systemic anticoagulation may also be provided through administration of low molecular weight heparins. Some research papers have discussed the use of thrombin antagonists (argatroban, bivalirudin) and heparinoids (danaparoid, fondaparinux), as well as platelet inhibitors as systemic anticoagulants. It is also possible to conduct extracorporeal blood purification without anticoagulation. C o n c l u s i o n s : The introduction of continuous extracorporeal blood purification techniques into everyday practice of intensive care units has brought many unquestioned benefits to the patients treated in this setting. On the other hand, it means that doctors need to show an in-depth knowledge of the anticoagulation methods. Despite the wider use of regional anticoagulation during continuous renal replacement therapy, systemic anticoagulation is still important. This is especially when therapies with high blood flow are performed and contraindications to citrate use are present.

scholarly journals MO861THE PROGNOSIS OF PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) AFTER CARDIOVASCULAR SURGERY DEPENDS ON THE INDICATION FOR ITS INITIATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nikolaos Schizas ◽  
Maria Smyrli ◽  
Aikaterini Dedeilia ◽  
Vasilios Patris ◽  
Ilias Samiotis ◽  
...  
Keyword(s):  
Survival Rate ◽  
Renal Replacement Therapy ◽  
Mortality Rate ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cardiovascular Surgery ◽  
High Survival ◽  
Key Factor ◽  
Life Threatening ◽  
First Time

Abstract Background and Aims Continuous Renal Replacement Therapy is required in 2.6% to 5% of patients who have undergone cardiovascular surgery. Although its implementation is frequent, several aspects of this therapeutic measure still remain uncertain. Method The data of all patients who were surgically treated during a 3-year period (2017-2019) at a single cardiovascular department were collected and the cases in which continuous renal replacement therapy was used were identified. From this group, the data of those that received dialysis for the first time were analyzed. Results In about 5% of patients renal replacement was inevitable, and the mortality rate among them reached 57.6%. The mean duration of renal therapy was 8.4 days. The investigation of laboratory parameters in different stages revealed certain aspects about the expected outcomes. The survival rate varied significantly in relation to the indication for CRRT. Fluid overload and electrolytic disorders were associated with high survival rate, while oliguria or anuria, acidosis or intoxications were linked to increased mortality rate. Conclusion Despite CRRT being associated with high mortality rates, it is the only option for life-threatening conditions in clinical practice. The indication for CRRT is a key factor for the prognosis, decision-making and the overall management of a patient.

scholarly journals Control of Hypercytokinemia in Critically Ill Epstein-Barr Virus Related Hemophagocytic Lymphohistiocytosis with Plasma Exchange and Continuous Renal Replacement Therapy

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2335-2335
Author(s):  
Chengshuang Huang ◽  
Pei Huang ◽  
Xueqin Jiang ◽  
Hongbo Xu ◽  
Jian Lu ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Critically Ill ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Epstein Barr Virus ◽  
Early Death ◽  
Barr Virus ◽  
Ebv Dna ◽  
Epstein Barr ◽  
Critical Ill

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a severe and potentially fatal disease associated with abnormal function of the immune system. Epstein-Barr virus (EBV) is one of the most common triggers of HLH, especially in Asian countries. The control of EBV-HLH is still a challenging issue, particularly the early mortality, which was mainly due to the multi-organ failure coursed by hypercytokinemia. Therefore, control the hypercytokinemia induced by EBV are very important in critical ill EBV-HLH patients. Extracorporeal blood purification techniques already have been successfully applied to control hypercytokinemia in sepsis and septic shock patients. But there are few studies by using plasma exchange (PE) and continuous renal replacement therapy (CRRT) to treat critically ill EBV-HLH. This study aimed to evaluate the effect of PE+CRRT in the control of hypercytokinemia in critical ill EBV-HLH patients. Material and methods: The diagnosis a series of critically ill EBV-HLH patients admitted to the pediatric intensive care unit (PICU) were confirmed by comparing to the clinical and laboratory criteria of the HLH-2004 consensus. Real time polymerase chain reaction was used to detect EBV-DNA copies in the patients' serum, all the patients showed a significantly increasing of EBV-DNA copies in the serum (>1×104 Copies/mL). With the approval of the Ethics Committee and informed consents from the guardians of the patients, PE and CRRT combined HLH-2004 chemo-immunotherapy was used to treat these cases at the initial treatment, all the PE and CRRT sessions were finished in 3-7 days according to the condition of the patients. In addition, other supportive treatments were applied accordingly. The levels of cytokines were measured by using the CBA Human Th1/Th2 Cytokine Kit II (BD Biosciences, San Jose, California). Death occurred in 30 days after the initiation of treatment was defined as early death. Results: Clinical symptoms of all patients were remarkably improved after the PE and CRRT sessions. The EBV-DNA copies in the patients' serum was significantly decreased to around the limits of detection. And the abnormal high levels of cytokines were rapidly recovered to normal values. More importantly, no serious side effects were observed during the treatment. In addition, all the patients except one patient who did not continue the therapy achieved complete remission after 4 weeks' treatment, and no early death occurred in 30 days after the initiation of the treatment. Furthermore, the EBV-DNA were undetectable in the serum of these patients after 6 months. The remissions of these patients were maintained for a median time of 17 months (13-22 months). Conclusions: PE+CRRT associated HLH-2004 chemo-immunotherapy is a safe and effective strategy to control hypercytokinemia in critically ill EBV-HLH patients, and may help in the reduction of early death. More data from randomized, large-scale and multicenter studies are needed to make this conclusion more reliable. Disclosures No relevant conflicts of interest to declare.

Continuous renal replacement therapy in the treatment of severe hyperkalemia: An in vitro study

2019 ◽  
Vol 43 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Pascal Houzé ◽  
Frédéric Joseph Baud ◽  
Jean-Herlé Raphalen ◽  
Anaïs Winchenne ◽  
Sonia Moreira ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
In Vitro Study ◽  
Central Compartment ◽  
Life Threatening ◽  
Severe Hyperkalemia ◽  
Continuous Filtration ◽  
Vitro Model

Introduction: Continuous renal replacement therapy is not presently recommended in the treatment of life-threatening hyperkalemia. There are no specific recommendations in hemodialysis to treat hyperkalemia. We hypothesized an in vitro model may provide valuable information on the usefulness of continuous renal replacement therapy to treat severe hyperkalemia. Methods: A potassium-free solute was used instead of diluted blood for continuous renal replacement therapy with a simulated blood flowrate set at 200 mL/min. The mode of elimination included continuous filtration, continuous dialysis, and continuous diafiltration using a flowrate of 4000 mL/min for continuous filtration and continuous dialysis modes, and a ratio of 2500/1500 in the continuous diafiltration mode. Results: The mean initial potassium in the central compartment was 10.1 ± 0.4 mmol/L. The clearances in the continuous diafiltration, continuous filtration, and continuous dialysis were 3.4 ± 0.5, 3.6 ± 0.1, and 3.7 ± 0.1 L/h, respectively, not significantly different. Continuous dialysis resulted in the lowest workload for staff. Increasing the continuous dialysis flowrates from 2000 to 8000 mL/h increased clearance from 2.3 ± 0.3 to 6.2 ± 0.8 L/h. The delays in decreasing the potassium concentration to 5.5 mmol/L dropped from 120 to 45 min, respectively. Potassium eliminated in the first hour increased from 18 to 38 mmol that compared favorably with hemodialysis. Decrease in simulated blood flowrate from 200 to 50 mL/min moderately but significantly decreased the clearance from 3.7 to 3.0 L/h. Conclusion: Hyperkalemia is efficiently treated by continuous renal replacement therapy using the dialysis mode. Caution is needed to prevent the onset of severe hypokalemia within 40 min after initiation of the session.

scholarly journals Propofol Infusion Syndrome: A Life Threatening Condition Blunted by Continuous Renal Replacement Therapy

2020 ◽  
Vol 5 (11) ◽  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Case Reports ◽  
Signs And Symptoms ◽  
High Dose ◽  
Short Term ◽  
Propofol Infusion Syndrome ◽  
Threatening Condition ◽  
Life Threatening

Propofol is a common intensive care unit anesthetic which was approved by FDA in 1989. It possesses sedative, anxiolytic, and anticonvulsant properties. Case reports of Propofol related infusion syndrome (PRIS) started in early 1990s. Reported signs and symptoms included acute refractory bradycardia, severe metabolic acidosis, cardiovascular collapse, lactic acidosis, rhabdomyolysis, hyperlipidemia, renal failure, and hepatomegaly. It is associated with both high dose cumulative and short-term infusions. This case report highlights the development of PRIS in a patient admitted to the ICU, symptoms of which were assumed to be blunted because of continuous renal replacement therapy support.

scholarly journals Practical issues of regional anticoagulation during continuous renal replacement therapy

2019 ◽  
Author(s):  
Dariusz Onichimowski ◽  
Joanna Maria Wolska ◽  
Radosław Borysiuk ◽  
Marcin Mieszkowski ◽  
Zuzanna Stępień ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Blood Purification ◽  
Bleeding Complications ◽  
Regional Citrate Anticoagulation ◽  
Extracorporeal Circuit ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Regional Anticoagulation

Introduction: Extracorporeal blood purification techniques have become a well-established part of routine practice in intensive care units. The issue of major concern while applying these techniques is to ensure appropriate anticoagulation to prevent the clotting of the circuit. Aim: The aim of this paper is to present regional anticoagulation as a method which is currently used in continuous extracorporeal blood purification techniques. Material and methods: This work is based on the available literature and the authors’ experience. Results and discussion: Anticoagulation used to prevent the clotting of the circuit in extracorporeal blood purification techniques may be regional or systemic. Regional anticoagulation inhibits clotting only in the extracorporeal circuit. In this case either sodium citrate together with calcium substitution or heparin with protamine sulfate is used. Systemic anticoagulation involves the inhibition of clotting in the extracorporeal circuit and in the patient’s body. Regional citrate anticoagulation (RCA) is obtained with the use of citrate. With this technique calcium substitution is necessary in order to prevent hypocalcemia. Other possible complications include alkalosis, metabolic acidosis, hypercalcemia and hypomagnesemia. This paper presents also some practical aspects of regional anticoagulation during continuous renal replacement therapy (CRRT) Conclusions: The application of RCA has contributed to a wider use of CRRT in intensive therapy units. The greatest advantage of this method is almost complete elimination of bleeding complications associated with the therapy. It enables effective blood purification in the patients in whom the use of heparins is contraindicated. This fact has found confirmation in Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

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