Effects of continuous renal replacement therapy with the AN69ST membrane for septic shock and sepsis-induced AKI in an infant: a case report with literature review of cytokine/mediator removal therapy in children

摘要

Background: Septic shock is a life-threatening condition and one of the most common causes of acute kidney injury (AKI). The acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane used in severe sepsis was formally launched in Japan in 2014, as a non-renal indication. This membrane provides hemofiltration in dialysis and improves hemodynamics in patients with sepsis and hypercytokinemia. However, the clinical literature regarding continuous renal replacement therapy (CRRT) with the AN69ST membrane is very limited, especially in infants. Case presentation: A 3-month-old female infant weighing 4.2 kg was hospitalized for septic shock and AKI secondary to necrotizing enterocolitis. Although she underwent palliative surgery, her vital signs did not recover from shock, and she developed reduced urine output. Her pediatric sequential organ failure assessment score was 10 points. Thus, we strongly suspected septic shock and sepsis-induced AKI, which were refractory to conservative treatment, and we decided to introduce CRRT with the AN69ST membrane for both renal replacement and antihypercytokinemic indications. After initiating CRRT for 72 h, her blood pressure increased sufficiently to maintain urine output, and improvements in the electrolyte abnormalities and metabolic acidosis were observed. Notably, her serum inflammatory cytokine levels decreased in parallel with improvement in her general condition. Despite successfully recovering from the AKI and being stable enough to allow discontinuing CRRT, she died of multiple organ dysfunction syndrome 3 weeks after CRRT was discontinued.Conclusions: CRRT may complement standard treatment in patients with sepsis-induced AKI to control the amplitude of the systemic inflammatory response regarding acute tissue and organ damage. We expect that CRRT with the AN69ST membrane will be recognized as an option for the treatment of septic shock and sepsis-induced AKI, even in infants.