title: Hemoperfusion treatment in a septic shock patient with autosomal dominant polycystic kidney disease and increased HMGB1 protein levels.
abstract: This case report describes polymyxin B-immobilized fiber (PMX-F) treatment of septic shock caused by pyelonephritis in a 68-year-old woman with autosomal dominant polycystic kidney disease. She was admitted for severe lower left abdominal pain, high fever (40°C) and gross hematuria. Her endotoxin and high-mobility group box-1 protein (HMGB1) levels were extremely elevated. Her blood pressure was 68/36 mm Hg. Urinalysis revealed innumerable white blood cells (WBCs). Blood and urine cultures were positive for Klebsiella pneumoniae and Pseudomonas aeruginosa. Plain abdominal radiography showed large kidney shadows and calcium deposition. Septic shock with endotoxemia was diagnosed. Her symptoms of septic shock persisted for 3 days with antibiotics, γ-globulin and dopamine. Direct hemoperfusion was performed twice with a PMX-F column. The patient's body temperature, WBC count and C-reactive protein level decreased. Her blood endotoxin level and blood HMGB1 level also decreased to an almost normal level. She was discharged on day 23 after admission.
authors.affiliation: Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawagoe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ueda
authors.forename: Shingo
authors.initials: S
authors.lastname: Yamada
authors.forename: Hikaru
authors.initials: H
authors.lastname: Koide
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D003997:Dicarbethoxydihydrocollidine / Q000031:analogs & derivatives* / Q000737:chemistry / Q000378:metabolism; D004731:Endotoxins / Q000009:adverse effects / Q000097:blood; D005260:Female; D024243:HMGB1 Protein / Q000097:blood; D006464:Hemoperfusion; D006801:Humans; D055767:Immobilized Proteins / Q000737:chemistry / Q000378:metabolism*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000254:growth & development; D007958:Leukocyte Count; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D011112:Polymyxin B / Q000737:chemistry / Q000378:metabolism* / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D005719:gamma-Globulins / Q000008:administration & dosage
chemical_list: C105562:2,6-dimethyl-3,5-diethoxycarbonyl-4-carboxyl-1,4-dihydropyridine; D000900:Anti-Bacterial Agents; D004731:Endotoxins; D024243:HMGB1 Protein; D055767:Immobilized Proteins; D005719:gamma-Globulins; D003997:Dicarbethoxydihydrocollidine; D002097:C-Reactive Protein; D011112:Polymyxin B