Early CRRT in A Post Kidney Transplantation Patient with Septic Schock

Introduction: Septic shock is still a major cause of morbidity and mortality in the intensive care unit (ICU), resulting in the deaths of more than 30 % in the first 28 days of treatment. Incident of urosepsis approximately 20-30 % of all sepsis. Mortality reaches 20-49 % when accompanied by shock. Transplant recipients who receive immunosuppressive drugs are at high risk of septic shock due to nosocomial infections. Proper treatment should be early and adequate to prevent organ failure and further complications. Objective: A 32-year-old man who had a history of kidney transplantation 6 months previously, was admitted to the ICU due to shock and respiratory failure. The patient had undergone cystoscopy evaluation, antegrade pyelography, cystography, and renal allograft nephrostomy replacement a day before ICU admission. The patient was diagnosed with septic shock due to urosepsis, hospital-acquired pneumonia (HAP), and acute kidney injury (AKI) post renal transplantation. Methodology: We did prospective observational descriptive analysis on this patient. The patient was intubated, given fluid resuscitation with crystalloid (Ringer Lactate) more than 20 ml/kgBW/hour with no response. Norepinephrine 1 mcg/kg/min and dobutamine 5 mcg/kgBW/min were given to reach mean arterial pressure (MAP)> 65 mmHg. Due to unstable hemodynamics, we decided to perform Continue Renal Replacement Therapy (CRRT) to remove inflammation mediator, which caused cytokine storm. Continue Venous-Venous Hemodiafiltration (CVVHDF) with dose 30-40 ml/kg/ hour was run for 5 days. Broad-spectrum antibiotics, blood glucose control, adequate volume status, nutritional support, and temporary with drawal of immunosuppressive drugs were ensured in dealing with sepsis. Results: On the day 5 the patient was stable with the minimal dose of vasopressor. The patient was extubated by day 8 and discharged from ICU 10 days later. The urine output was more than >0.5 ml/kgBW/hour and creatinine levels tend to decrease. Conclusion: Early CRRT could prevent organ failure and further complications caused by septic shock by removing inflammation mediators.