Abstract

Early Continuous Renal Replacement Therapy and Antibiotic Management in Shock Patients due to Urosepsis with Immunocompromised Post Renal Transplantation

Introduction: Septic shock is still a major cause of morbidity and mortality in the intensive care unit (ICU), resulting in the death of more than 30% in the first 28 days of treatment. Mortality reaches 20-49% when accompanied by shock. Transplant recipients who receive immunosuppressive drugs are at high risk of septic shock due to nosocomial infections. Case Report: A 32-year-old man, who had a history of kidney transplantation, was admitted to the ICU due to shock and respiratory failure. The patient had undergone cystoscopy evaluation, ante grade pyelography, cystography, and renal allograft nephrostomy replacement a day before ICU admission. The patient was diagnosed with septic shock due to urosepsis, hospital-acquired pneumonia (HAP), and acute kidney injury (AKI) post renal transplantation. Prospective observational descriptive analysis was performed on the patient. The patient was intubated, given fluid resuscitation with crystalloid (ringer lactate) more than 20 ml/kg/hour with no response. Norepinephrine 1 mcg/kg/min and dobutamine 5 mcg/kg/min were given to reach mean arterial pressure (MAP)>65 mmHg. Due to unstable hemodynamics, continue renal replacement therapy (CRRT) was performed to remove inflammation mediator, which caused cytokine storm. Continuous venous-venous hemodiafiltration (CVVHDF) with dose 30-40 ml/kg/hour was run for 5 days. On day 5 the patient was stable with the minimal dose of vasopressor. The patient was extubated by day 8 and discharged from ICU 10 days later. The urine output was >0.5 ml/kg/hour and creatinine levels tend to decrease. Conclusion: Early CRRT could prevent organ failure and further complications caused by septic shock by removing inflammation mediators.

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