Continuous plasma exchange with dialysis for thrombotic microangiopathy in intensive care unit: Retrospective observational study.

Continuous plasma exchange with dialysis is a novel method of blood purification and is a modification of the plasma exchange. Technically, this process suggests a reduction in adverse events, cost-effectiveness, and compatibility with hemodynamic instability. The therapeutic effect of plasma exchange on thrombotic microangiopathies has been established. We present three clinical cases in the intensive care unit that illustrate continuous plasma exchange with dialysis as a flexible blood purification therapy for critically ill patients; a radical treatment, thrombotic microangiopathies; supportive therapy, multiple organ failure; and fluid balance regulator. The retrospective analysis of 13 continuous plasma exchange with dialysis sessions showed that the platelet count increased significantly (p = 0.0096) after its administration. The total protein, albumin, fibrinogen, or calcium did not decrease significantly after continuous plasma exchange with dialysis, suggesting therapeutic efficacy and fewer adverse events. A prospective study on thrombotic microangiopathies for continuous plasma exchange with dialysis is currently underway.

A case of cardiac arrest due to a ruptured renal artery pseudoaneurysm, a complication of renal biopsy.

Renal artery pseudoaneurysms (RAPs) are a rare complication of percutaneous kidney biopsies that generally present as hematuria and back pain and are treated with angioembolization. A 60-year-old man was admitted to our emergency department for sudden left back pain. He was taking an oral anticoagulant for atrial fibrillation. He had undergone an ultrasound-guided percutaneous renal biopsy 26 days prior. We diagnosed him with hemorrhagic shock from the renal artery. Although he received a massive rapid blood transfusion, he went into cardiac arrest. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed and, within 10 min, the patient achieved return of spontaneous circulation and regained consciousness. Subsequently, angioembolization was successfully performed for a 12.5 mm × 5.9 mm pseudoaneurysm in the left renal inferior pole close to the site of the renal biopsy. A total of 1680 mL of red blood cells and fresh frozen plasma were administered respectively until hemostasis was completed. He was then treated with continuous hemodialysis in the intensive care unit (ICU) for 6 days. He stayed in the ICU for 9 days and was moved to the general ward with full neurological recovery and a sufficiently stable condition to be able to walk. In conclusion, clinicians should be aware of the possibility of severe hemorrhagic shock due to RAPs after renal biopsy. Moreover, even if the patient goes into cardiac arrest, there is a possibility of full recovery if REBOA is performed and angioembolization is completed.