Piscitani Luca, Di Vito Roberto, Tunno Marilena, Bonomini Mario
Nephrology and Dialysis Unit, Department of Medicine, San Salvatore Hospital, L'Aquila, Italy.
Nephrology and Dialysis Unit, Department of Medicine, SS. Annunziata Hospital, Chieti, Italy.
Ther Apher Dial. 2023 Apr;27(2):278-283. doi: 10.1111/1744-9987.13909. Epub 2022 Jul 25.
Acute liver failure (ALF) is a rare syndrome defined by the rapid loss of liver function in the absence of pre-existing liver disease, which may be secondary to hepatitis A virus, hepatitis E virus (HEV), or to drugs in about 50% of cases. Extracorporeal albumin dialysis enables the elimination of albumin-bound toxins that accumulate in liver failure.
We report a case of ALF secondary to HEV associated with severe hyperbilirubinemia. Patient was treated with four consecutive sessions of single-pass albumin dialysis (SPAD) carried out setting the following parameters: time: 300 min, Qb: 60 mL/min, Qd: 800-1000 mL/min, dialysate containing 4% albumin, citrate: 3-4 mmol/L.
SPAD documented good support of liver function. Bilirubin levels were reduced from 22 to 14 g/dL after four treatments. Pruritus was the first clinical sign of improvement.
SPAD system can represent a safe and effective therapeutic option.
急性肝衰竭（ALF）是一种罕见的综合征，其定义为在无既往肝病的情况下肝功能迅速丧失，约50%的病例可能继发于甲型肝炎病毒、戊型肝炎病毒（HEV）或药物。体外白蛋白透析能够清除肝衰竭时蓄积的与白蛋白结合的毒素。
我们报告1例继发于HEV且伴有严重高胆红素血症的急性肝衰竭病例。患者接受了4次连续的单次通过白蛋白透析（SPAD）治疗，设置以下参数：时间：300分钟，血流量（Qb）：60毫升/分钟，透析液流量（Qd）：800 - 1000毫升/分钟，透析液含4%白蛋白，枸橼酸盐：3 - 4毫摩尔/升。
单次通过白蛋白透析显示出对肝功能的良好支持作用。经过4次治疗后，胆红素水平从22降至14克/分升。瘙痒是改善的首个临床征象。
单次通过白蛋白透析系统可成为一种安全有效的治疗选择。
