A case of acute kidney insufficiency caused by severe acute panceatitis after endoscopic retrograde cholangiopancreatography that was successfully treated with sustained low-efficiency dialysis with filtration

Abstract

A 78-year-old man was referred to our department with acute kidney insufficiency (AKI). He had undergone endoscopic retrograde cholangio pancreatography (ERCP) for obstructive jaundice. After ERCP, he developed severe acute pancreatitis. His renal function, respiratory condition, and level of consciousness gradually worsened. We started sustained low-efficiency dialysis with filtration (SLED-f), expecting improvement of his AKI and respiratory condition, and removal of middle molecular weight substances. Following were the parameters for SLED-f: time, 6h; dialyzer PMMA membrane, 2.1m²; QB (blood flow rate), 100mL/min; QD (dialysate flow rate), 300mL/min; QF (hemofiltration flow rate), 1.2L/h with post-dilution. After three sessions of SLED-f and four sessions of intermittent hemodialysis, his respiratory condition and level of consciousness gradually improved. Contrary to our expectations, there were no changes in interleukin-6 before and after hemodialysis. SLED-f was performed and hemodynamic stability was maintained. We allowed the patient to stay in the hospital ward not in the ICU, thus enabling diagnostic imaging examinations.