Yohanes Gunanta Bangun Tzu Chi Hospital Hanna Hidayat Tzu Chi Hospital

Keywords: Acute Renal Failure, CVVHDF, Hemodialysis, Laparotomy, Sepsis

Abstract

Acute renal failure (ARF) is a condition that may occurs in susceptible postoperative patients. The incidence of ARF reaches 30−60% and it is more after major surgery (e.g., laparotomy, heart surgery). It is often caused by hypovolemia, hypoperfusion, and systemic inflammation. Laparotomy is a major and complex operation that can lead to complications including ARF, acute pulmonary edema, sepsis, and increased morbidity and mortality.

A 76-year-old female patient underwent exploratory laparotomy for acute abdominal indications with suspected obstructive ileus with sepsis. Postoperatively, the patient was treated in the ICU using a ventilator. On the third day the patient's renal function and urine volume decreased. Creatinine level 5.19 mg/dL, urea 217 mg/dL and urine was 0.2 ml/kg/h. The patient was given diuretics but she did not show clinical and laboratory improvement. We decided to perform hemodialysis with continuous veno-venous hemodiafiltration (CVVHDF) mode because the patient was in septic condition and hemodynamic instability. CVVHDF was performed for three days, periodic laboratory examinations were performed to assess the patient's renal function. After three days CVVHDF, the clinical and laboratory indices improved and the patient could be extubated. Hemodialysis with CVVHDF mode has benefits in ARF, especially if the patient has unstable hemodynamics.

Key words: Acute Renal Failure; CVVHDF; Hemodialysis, Laparotomy, Sepsis

Citation: Bangun YG, Hidayat H. Management of acute renal failure with CVVHDF in a patient with sepsis after post exploratory laparotomy: a case report. Anaesth. pain intensive care 2022;27(1):131−134.

DOI: 10.35975/apic.v27i1.2086

Received: December 11, 2022; Reviewed: December 22, 2022; Accepted: January 12, 2023

Author Biographies

Yohanes Gunanta Bangun, Tzu Chi Hospital

TZU CHI Hospital Pantai Indah Kapuk, Jakarta, Indonesia, 14470

Hanna Hidayat, Tzu Chi Hospital

TZU CHI Hospital Pantai Indah Kapuk, Jakarta, Indonesia, 14470