RENAL REPLACEMENT THERAPY IN A POLYTRAUMATIZED PATIENT WITH HEMOPHILIA

Abstract

Zatajenje bubrežne funkcije je rijetka pojava u bolesnika s nasljednim koagulacijskim poremećajima. Međutim, kada nastupi veoma brzo napreduje do završnog stadija bubrežne bolesti i potrebe za nadomještanjem bubrežne funkcije. Javljaju se problemi vezani uz odabir metode dijalize, periproceduralne nadoknade nedostatnog faktora koagulacije te heparinizacije dijaliznog sustava. Kod hemoiličara uvijek treba biti oprezan tijekom samog postupka dijalize zbog mogućeg razvoja komplikacija koje ih mogu vitalno ugroziti. Ovo je prikaz slučaja teško politraumatiziranog bolesnika koji boluje od hemofilije A. Tijekom intenzivnog liječenja razvio je akutno bubrežno zatajenje te tešku sepsu. S obzirom na okolnosti najbolja metoda izbora za njega je bila kontinuirana veno-venska hemodijaliza. Unato uspješno provedenoj dijalizi bez komplikacija bolesnik umire od protrahirane sepseRenal failure is a rare complication of hereditary coagulopathies. However, when it occurs, it rapidly progresses to a stage that requires replacement of renal function. Major problems include the choice of dialysis method, prevention of complications and supplementation of deicient factor. In hemodialysis, it is challenging to prevent system clotting and avoid bleeding. We present a case of polytraumatized male patient with hemophilia A, who developed compartment syndrome with acute renal failure. Continuous venovenous hemodialysis (CVVHD) improved his condition and he recovered his kidney function. However, over the next few days he developed severe sepsis with deterioration of renal function. CVVHDF (hemodiailtration) was restarted. Several large hematomas were found in the abdominal cavity and in the inguinal region, one of them inducing compartment syndrome with leg necrosis. The patient died from cardiorespiratory arrest