A case of acute renal failure caused by paroxysmal nocturnal hemoglobinuria.

DOI 1 Citations 10 References
  • Takeda Yoko
    <I>Department of Anesthesiology-Resuscitology, Critical Care Medical Centre, Yamaguchi University Hospital</I>
  • Soejima Yoshiyuki
    山口大学医学部附属病院集中治療部
  • Nakashima Ken
    山口大学医学部附属病院集中治療部
  • Yamamoto Midori
    山口大学医学部附属病院総合診療部
  • Tateishi Akio
    山口大学医学部附属病院総合診療部
  • Sakabe Takefumi
    <I>Department of Anesthesiology-Resuscitology, Critical Care Medical Centre, Yamaguchi University Hospital</I>

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Other Title
  • 急性腎不全を合併した発作性夜間血色素尿症の１症例

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Abstract

We have experienced a case of acute renal failure caused by paroxysmal nocturnal hemoglobinuria, in which blood purification therapy was effective.<BR>A 44-year-old male patient complained abdominal pain with fever and cough 2 days before his admission. He was anuretic complicated with severe hemolytic crisis. Steroid pulse therapy, administration of haptoglobin, and volume loading with diuretics all failed to improve oliguria. Con-tinuous hemodiafiltration (CHDF) was started on ICU Day 1, followed by continuous equilibration peritoneal dialysis (CEPD) on Day 11. The patient was placed on ventilator, and was successfully weaned from it at 18 th day. Then, he regained normal urinary output, and per-itoneal dialysis was discontinued on Day 21.<BR>The concentration of C 3 a in post-hemofilter blood was less when polyacrylonitrile (PAN) was used than when polymethyl methacrylate (PMMA) was used.<BR>Acute renal failure is not frequently associated with paroxysmal nocturnal hemoglobinuria. With this patient, upper respiratory tract infection would trigger severe hemolytic crisis, and dehydration from fever and vomiting exacervated his physical condition, leading to acute renal failure. Early intensive care with CHDF/CEPD provided favorable outcome for this patient.

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