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Case Reports
. 2023 May 17;17(1):201.
doi: 10.1186/s13256-023-03923-z.

Early continuous renal replacement therapy for postoperative patient with acute kidney injury following total pancreato-splenectomy: a case report

Apriliana Ratnaningrum  1 , M Azhari Taufik  2 , Vera Irawany  2 , Rudyanto Sedono  3
Affiliations
Case Reports

Early continuous renal replacement therapy for postoperative patient with acute kidney injury following total pancreato-splenectomy: a case report

Apriliana Ratnaningrum et al. J Med Case Rep. .

Abstract

Background: Acute kidney injury is a devastating postoperative complication. Renal replacement therapy is a treatment modality for acute kidney injury. Continuous renal replacement therapy is the treatment of choice for patients with hemodynamic instability. The main question in the management of acute kidney injury is when to initiate the renal replacement therapy. Several studies have demonstrated improvement in patients with septic acute kidney injury, following early continuous renal replacement therapy. To date, no guidelines have been established on the perfect timing to initiate continuous renal replacement therapy. In this case report, we did an early continuous renal replacement therapy as an extracorporeal therapy for blood purification and renal support.

Case presentation: Our patient was a 46-year-old male of Malay ethnicity, undergoing total pancreatectomy due to a duodenal tumor. The preoperative assessment showed that the patient was high risk. Intraoperatively, massive surgical bleeding was sustained due to extensive tumor resection; thus, massive blood product transfusion was necessary. After the surgery, the patient suffered from postoperative acute kidney injury. We performed early continuous renal replacement therapy, within 24 hours after the diagnosis of acute kidney injury. Upon completion of continuous renal replacement therapy, the patient's condition improved, and he was discharged from the intensive care unit on the sixth postoperative day.

Conclusion: The timing for the initiation of renal replacement therapy remains controversial. It is clear that the "conventional criteria" for initiating renal replacement therapy need correction. We found that early continuous renal replacement therapy initiated in less than 24 hour after the postoperative acute kidney injury diagnosis gave our patient survival benefit.

Keywords: Acute kidney injury; Case report; Early continuous renal replacement therapy; Pancreato-splenectomy; Postoperative.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships related to any patents, patent applications, products in development, or for a market that could have appeared to influence the work reported in this paper.

Figures

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Postoperative urine output (cc)
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Postoperative CRP level (mg/dL)
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Postoperative blood glucose level (mg/dL)
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CRRT prescription
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Patient’s timeline since ICU admission
See this image and copyright information in PMC

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