Changes in urinary L-type fatty acid binding protein during polymyxin B-immobilized fiber column direct hemoperfusion therapy for acute pancreatitis after ERCP：a case report

Abstract

The patient was a 63-year-old woman who had a common bile duct stone, which was removed by endoscopic retrograde cholangiopancreatography, followed by endoscopic retrograde biliary drainage. She subsequently developed acute pancreatitis, which did not improve with pancreatic enzyme inhibitor treatment. The patient developed sepsis and underwent polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP). Urinary L-type fatty acid binding protein (L-FABP) was raised (485.2μg/g Cre) before PMX-DHP, suggesting that acute kidney injury was inevitable. Therefore, continuous hemodiafiltration was performed using PMMA membrane. Urinary L-FABP decreased to 364.7μg/g Cre after the first PMX-DHP, and decreased from 177.7μg/g Cre to 5.4μg/g Cre after the second PMX-DHP. Acute pancreatitis improved and the renal function did not worsen (serum creatinine: 0.4mg/dL). In this patient, serum creatinine was normal, but urinary L-FABP was high and proximal tubular injury was observed. Therefore, acute kidney injury may be avoided by early renal replacement therapy. Additionally, urinary L-FABP may be used for early diagnosis of acute kidney injury.