Bilirubin Removal With Therapeutic Plasma Exchange Or Molecular Adsorbent Recirculating System (MARS®) As Treatment For Cholemic Nephropathy In Patients With Cirrhosis and ACLF: A case series.
Natalia Jiménez-Esquivel, Gastón Piñeiro, Adrià Carpio, Oswaldo Ortiz, Miquel Lozano, Leonardo Rodríguez-Carunchio, María Del Carmen Salgado, David Toapanta, Joan Cid, Octavi Bassegoda, Elena Cuadrado-Payán, Miquel Sanz, Paola Charry, Esteban Poch, Javier Fernández, Enric Reverter
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Abstract
Introduction: Cholemic nephropathy is an overlooked cause of acute kidney injury (AKI) in patients with advanced cirrhosis and high bilirubin plasma levels (usually above 20mg/dl), due to bilirubin and bile acid deposition in the kidneys. Those deposits have been hypothesized to cause tubular injury. It has no standardized diagnostic criteria or therapeutic strategies.
Methods: We present a series of fifteen patients with cirrhosis and severe cholemic AKI, diagnosed by microscopic urinary cast visualization after excluding and treating other causes of AKI. Bilirubin plasma removal was performed with albumin dialysis (n=3) or plasma exchange (n=12) to treat and prevent further kidney deterioration.
Results: Kidney function improved in most of the patients, five patients also required transient haemodialysis, with only one patient evolving to end stage chronic kidney disease needing liver-kidney transplant. Five patients underwent extended PE sessions as a bridge to liver transplantation. Survival at 30 days and 1 year was 80% and 73%, respectively, with 10 patients undergoing transplantation along this year.
Conclusion: In this highly selected cohort of patients with terminal cirrhosis and severe cholemic AKI extracorporeal plasma removal techniques seem to improve kidney function and overall prognosis. Larger prospective and controlled studies are required to better understand this condition.
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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