Bioelectrical impedance analysis (BIA) can be used to calculate extracellular water and total body water levels. The edema index (the extracellular body water to total body water ratio) is widely used as a fluid status indicator. This study examined the changes in the edema index observed after various types of kidney transplantation (KT), and assessed the association between the edema index and renal function. We retrospectively investigated 115 patients who underwent KT between October 2006 and May 2016 at Nara Medical University and for whom BIA data were available. BIA data were obtained weekly from just before the KT until the 3rd postoperative week. The chronological changes in the edema index and renal function were compared between living― and deceased‒donor KT, and between preemptive and non‒preemptive KT. Of the 115 recipients, 104 (90.4％) and 11 (9.6％) were living‒donor and deceased‒donor KT recipients, respectively. Of the 104 living‒donor kidney transplant recipients, 27 (26.0％) and 77 (74.0％) were preemptive and non‒preemptive kidney transplant recipients, respectively. The living‒donor KT recipients had a significantly lower mean edema index than the deceased‒donor KT in the 3rd week, and the preemptive KT recipients had a significantly lower mean edema index than the non‒preemptive KT recipients in the 2nd and 3rd weeks after KT. The living‒donor KT recipients had significantly better renal function than the deceased‒donor KT recipients in each week. There was no difference in renal function between the preemptive KT and non‒preemptive KT recipients. The period of decreasing fluid status was shorter in the living‒donor KT recipients than in the deceased‒donor KT recipients, and pre-emptive KT produced similar results to non‒preemptive KT. BIA‒based fluid status measurements may be useful for predicting early graft function recovery and accurate volume control after KT.

We report an autopsy case of fulminant multiorgan failure induced by thrombotic thrombocytopenic purpura (TTP) in a 78‒year‒old male complaining of fever and fatigue. When he was referred to our hospital in August 201X, blood tests revealed thrombocytopenia, hemolysis, and severe renal dysfunction, and a disturbance of consciousness was observed, leading to a suspicion of TTP. We immediately started plasma exchange, methylprednisolone pulse therapy, and hemodialysis, but he went into cardiopulmonary arrest that night and spontaneous resuscitation, intra‒aortic balloon pumping, and extracorporeal membrane oxygenation (ECMO) were employed to save his life. On each day of the patientʼs hospitalization, plasma exchange and hemodialysis were performed, and steroid treatment was administered, but they were ineffective, and the patient died on day 7. Later, his ADAMTS13 activity was found to be below the limit of detection, and he was diagnosed with TTP. An autopsy showed ischemic multiorgan failure due to multiple microthrombi, and the cause of death was diagnosed as ischemic cardiomyopathy. In cases like this one, in which the patient does not respond to standard treatment and shows a rapid course of thrombotic multiorgan failure, another treatment strategy, such as the use of caplacizumab, may be needed.

A male in his 60s visited our hospital with chief complaints of increased body weight and exertional dyspnea. He had a history of nephrosclerosis associated with chronic kidney disease, for which he had been receiving combined modality therapy for 9 years. He was admitted with acute decompensated heart failure. Following the administration of cardiotonic drugs, the patientʼs body weight decreased, and his dyspnea improved. The discontinuation of the cardiotonic drugs resulted in weight gain and dyspnea. Peritoneal dialysis (PD) was initiated to control body fluid accumulation. The PD catheter placement was performed via an open surgical technique on the 79^th day of hospitalization. The patient exhibited gross hematuria for a short time after the operation. PD was started on the 84^th day of hospitalization. The patientʼs urinary volume increased after the infusion of PD fluid, and bladder perforation by the PD catheter was suspected. Computed tomography revealed the presence of the PD catheter in the patientʼs bladder, and PD was discontinued. The patient underwent PD catheter removal, bladder repair, and the insertion of a second PD catheter on the 88^th day of hospitalization. PD was resumed without adverse events on the 105^th day of hospitalization. It is important to take adequate precautions during PD, as bladder perforation by a PD catheter may cause peritonitis and require the suspension of PD.