The role of CRRT in the management of sepsis-associated acute kidney injury: case report

Sepsis is an uncontrolled immunological host reaction to infection that causes organ dysfunction. Mortality related to sepsis-associated acute kidney injury (SA-AKI) is 30%-60%. A 62-year-old woman presented to emergency room (ER) of Fatmawati Hospital with decreased consciousness for one day. Complaints of productive cough, fever, and shortness of breath were noted. We found hypotension with cold extremities, fever, tachycardia, and labored breathing. Her SOFA score was 12, blood glucose level was very high, urine production was less than 0.5 ml/kg/h in 6 h, high creatinine level (1.69 mg/dL), fluid balance +643 ml/6 h, and chest X-ray showing bilateral infiltrates. The patient was intubated to reduce work of breathing and stabilize hemodynamics. Management of the sepsis bundle was initiated by administration of vasopressors despite adequate fluid intake and two broad-spectrum antibiotics (meropenem and levofloxacin). On the second day, continuous renal replacement therapy (CRRT) was performed due to oliguria and worsened AKI caused by septic shock. After 48 h of CRRT, the patient clinically improved. The patient was extubated successfully on the fifth day of treatment.