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Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series

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Abstract

Acute fatty liver of pregnancy (AFLP) complicated by acute kidney injury (AKI) is serious and life-threatening for the mother. The present study aimed to determine the clinical efficacy of combined blood purification treatment (CBPT) in patients with AFLP complicated by AKI. The CBPT involves plasma exchange (PE) combined with continuous venovenous hemofiltration (CVVH). The subjects were 17 patients with AFLP complicated by AKI. The CBPT was implemented based on the timely termination of pregnancy and general treatment. Changes in clinical manifestations, laboratory tests, liver ultrasounds, as well as Sequential Organ Failure Assessment (SOFA) and Glasgow scores were evaluated. The efficacy and adverse reactions of the CBPT were also assessed. The CBPT was smoothly performed without any obvious adverse reaction. After treatment, the clinical manifestations, laboratory examinations, and liver ultrasonography significantly improved. Therefore, the SOFA scores correspondingly decreased 1 week after treatment [9 (range 5–11) vs. 3 (range 0–10), P = 0.002], and the median was close to normal by the second week. The clearance rate of the total bilirubin in PE was significantly higher than that in CVVH (37.2 vs. 7.9%, P = 0.000). The incidence of acute pulmonary edema in CVVH was less than that in PE (0 vs. 41.2%, P = 0.007). Finally, the maternal mortality was 5.88% (95% CI: 0–29%). Overall, we think that CBPT aids in the recovery of liver and kidney function. Different blood purification methods may be combined to integrate and maximize their advantages to improve the prognoses of patients with serious AFLP.

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Abbreviations

AFLP:

Acute fatty liver of pregnancy

AKI:

Acute kidney injury

PE:

Plasma exchange

CVVH:

Continuous venovenous hemofiltration

CBPT:

Combined blood purification treatment

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Acknowledgments

We thank Dr. Xiao Xi Zeng for writing assistance.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China

    Wan Xin Tang, Tian Lei Cui, Ling Zhang & Ping Fu

  2. West China Second Hospital of Sichuan University, Chengdu, China

    Zhong Ying Huang

  3. No. 3 People’s Hospital of Chengdu, Chengdu, China

    Ze Jun Chen

Authors
  1. Wan Xin Tang
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  2. Zhong Ying Huang
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  4. Tian Lei Cui
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Correspondence to Ping Fu.

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Tang, W.X., Huang, Z.Y., Chen, Z.J. et al. Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series. J Artif Organs 15, 176–184 (2012). https://doi.org/10.1007/s10047-011-0621-5

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  • DOI: https://doi.org/10.1007/s10047-011-0621-5

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