Hui Wun Fung, Hon Kam Lun, Lun Kin Shing, Leung Karen Ka Yan, Cheung Wing Lum, Leung Alexander K C
Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong.
Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, AB T2M 0H5, Canada.
Case Rep Pediatr. 2021 Oct 4;2021:2148024. doi: 10.1155/2021/2148024. eCollection 2021.
We report two children with rhabdomyolysis-associated acute kidney injury who were successfully treated with a haemoadsorption column CytoSorb® in addition to continuous renal replacement therapy (CRRT). A 14-year-old girl with multiorgan failure requiring extracorporeal membrane oxygenation developed rhabdomyolysis due to reperfusion injury. Her creatine kinase (CK) and lactate levels continued to escalate despite high-dose CRRT. A haemoadsorption column was therefore added post-CRRT filter, which brought down the CK level from 264,500 IU/L to 97,436 IU/L after 8 hours of therapy. Another 4-year-old boy with epilepsy and cerebral palsy who was admitted for gastroenteritis with dehydration developed acute kidney injury and rhabdomyolysis with a peak CK level of 946,060 IU/L. He was initially treated with CRRT for 40 hours, which reduced his CK level to 147,580 IU/L. Two sessions of haemoadsorption were then performed in addition to the CRRT, which further lowered his CK level to 32,306 IU/L in 48 hours. Both patients demonstrated enhanced reduction of CK levels when the haemoadsorption column was used in addition to the CRRT, and no specific complication related to the haemoadsorption therapy was reported. Our cases showed that haemoadsorption can be considered as an adjunctive therapy for children with severe rhabdomyolysis-associated acute kidney injury.
我们报告了两名横纹肌溶解相关急性肾损伤患儿，除接受持续肾脏替代治疗（CRRT）外，还成功接受了血液吸附柱CytoSorb®治疗。一名14岁患有多器官功能衰竭且需要体外膜肺氧合的女孩因再灌注损伤发生横纹肌溶解。尽管进行了高剂量CRRT，她的肌酸激酶（CK）和乳酸水平仍持续升高。因此，在CRRT滤器后置入血液吸附柱，治疗8小时后CK水平从264,500 IU/L降至97,436 IU/L。另一名4岁患有癫痫和脑瘫的男孩因胃肠炎伴脱水入院，发生急性肾损伤和横纹肌溶解，CK峰值水平为946,060 IU/L。他最初接受了40小时的CRRT治疗，CK水平降至147,580 IU/L。随后在CRRT基础上又进行了两次血液吸附治疗，48小时内CK水平进一步降至32,306 IU/L。两名患者在CRRT基础上加用血液吸附柱后，CK水平均有更明显下降，且未报告与血液吸附治疗相关的特定并发症。我们的病例表明，血液吸附可被视为严重横纹肌溶解相关急性肾损伤患儿的辅助治疗方法。
