Continuous renal replacement therapy combined with double filtration plasmapheresis in the treatment of severe lupus complicated by serious bacterial infections in children: A case report

There are few reports available on the combination therapy of continuous renal replacement therapy (CRRT) and double filtration plasmapheresis (DFPP) in patients with systemic lupus erythematosus (SLE) complicated by severe bacterial infections, especially in children. A 14-year-old female child with recurrent SLE complicated by severe sepsis-induced multiple organ dysfunction syndrome was administered CRRT combined with DFPP for blood purification in addition to routine immunosuppressant therapy. The changes in autoantibodies, cytokines, and coagulation function indexes of the patient before and after treatment were compared to explore the effect of such therapy on progression and prognosis. After DFPP therapy, significant decreases in the levels of double-stranded DNA antibody, cytokines interleukin (IL)-6, IL-10, and procalcitonin (PCT) were observed. Fibrinogen (Fib) decreased and needed to be replenished following DFPP. After CRRT combined with DFPP, the patient began to urinate sparingly (urine volume was < 50 mL/day) at the seventh week, the urine volume was > 400 mL/day (up to 560 mL/day) at the ninth week (63 days), and the urine volume was >1,000 mL/day at the tenth week, at which time the renal function had fully recovered. DFPP may reduce the plasma Fib concentration, which needs to be replenished in a timely manner. CRRT combined with DFPP shows efficacy in patients with SLE, but the coagulation function requires close monitoring.