HA330-II HEMOADSORPTION IN THE MANAGEMENT OF ACUTE KIDNEY INJURY AND INTRAHEPATIC CHOLESTASIS OF PREGNANCY: A CASE REPORT

 

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HA330-II HEMOADSORPTION IN THE MANAGEMENT OF ACUTE KIDNEY INJURY AND INTRAHEPATIC CHOLESTASIS OF PREGNANCY: A CASE REPORT

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Jovitte Suzane
Esporlas
Jovitte Suzane Esporlas jovitteyalong@gmail.com East Avenue Medical Center Nephrology Quezon City Philippines *
Roland Dela Cruz rdlc_md@outlook.com East Avenue Medical Center Nephrology Quezon City Philippines -
Mariano Maisie Mae Kathleen maisiemaemariano@gmail.com East Avenue Medical Center Nephrology Quezon City Philippines -
 
 
 
 
 
 
 
 
 
 
 
 

This case demonstrates the potential role of HA 330-II hemoperfusion, alongside hemodialysis, in managing acute kidney injury (AKI) and intrahepatic cholestasis of pregnancy (ICP). By reducing bile acids and inflammatory mediators, it may improve maternal-fetal outcomes in high-risk obstetric cases.

A 29-year-old G1P0 at 15 weeks gestation presented with persistent vomiting since week 6. Initially treated as hyperemesis gravidarum, she later developed AKI, elevated liver enzymes, anemia, and jaundice. Ancillaries revealed elevated creatinine, BUN, bilirubin, and transaminases. Abdominal ultrasound was unremarkable. Patient was managed as case of Intrahepatic Cholestatis of Pregnancy and Stage III Prerenal AKI secondary to hyperemesis gravidarum.

On hospital day 2, the patient underwent hemodialysis for 2.5 hours with a blood flow rate of 150 mL/min, dialysate flow rate of 300 mL/min, no ultrafiltration, bicarbonate bath, low-flux dialyzer, and saline flushes every 30 minutes. On day 3, she was transferred to the ICU for close monitoring and underwent combined hemodialysis and hemoperfusion (HDHP) for 5 hours using a low-flux dialyzer and HA 330-II cartridge, with a blood flow rate of 200 mL/min, dialysate flow rate of 500 mL/min, and albumin 20% during the last hour, followed by calcium gluconate IV. On day 4, she received 2 hours of hemodialysis and 3 hours of hemoperfusion with similar parameters. Medications included doxylamine-pyridoxine, ferrous sulfate-folic acid, calcium carbonate, ursodeoxycholic acid, Hepatek, and prenatal vitamins. With clinical and laboratory improvement, the patient was transferred to the regular ward and discharged without need for long-term dialysis.

Figure 1. Progressive decline in kidney markers post treatment. HD, hemodialysis; HP, hemoperfusion.

Figure 2. Bilirubins drop after the second hemoperfusion. HP, hemoperfusion.

Figure 3. Aminotransferases progressively decline post treatment. HD, hemodialysis; HP, hemoperfusion.

HA 330-II hemoperfusion may benefit obstetric liver disorders by reducing inflammation and bile acids, potentially improving maternal-fetal outcomes.

Kewords