Prolonged renal replacement therapy in the complex treatment of acute kidney injury in a child with meningococcal infection: a case report
INFECTIOUS DISEASES
Abstract
Invasive meningococcal infection in young children may progress rapidly to sepsis, septic shock, and multiple organ dysfunction. We report a case of a 2-year-old child with generalized meningococcal infection (meningococcemia and meningitis) complicated by sepsis, septic shock, multiple organ dysfunction syndrome, and severe acute kidney injury (p RIFLE Injury; KDIGO stage 2–3). In the pediatric intensive care unit, the patient received comprehensive treatment including vasoactive support, combined antimicrobial therapy, transfusion therapy, oxygen/noninvasive ventilatory support, and prolonged renal replacement therapy using continuous veno-venous hemodialysis (CVVHD). On day 5 of illness, persistent oliguria, azotemia, pathologic fluid overload, and a renal angina index of 8 points prompted initiation of prolonged renal replacement therapy for 40 hours 30 minutes. Treatment resulted in hemodynamic stabilization, recovery of urine output, regression of inflammatory and neurologic manifestations, reduction of azotemia, and subsequent transfer from the intensive care unit. This case highlights the multifactorial nature of acute kidney injury in generalized meningococcal infection and the value of timely individualized extracorporeal renal support as part of complex intensive care.
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