A Case of Acute Renal Failure Associated with Acute Fulminant Hepatitis A / 대한신장학회잡지

ABSTRACT

Hepatitis A is a common cause of acute hepatitis throughout the world and is usually a mild self-limiting disease of the liver, but rarely presents as fulminant hepatitis in 0.14-0.35% of acute hepatitis A. Acute renal failure requiring dialysis in acute hepatitis A is also exceeding rare. We here report an unusual case of acute renal failure associated with acute fulminant hepatitis A. A previously healthy 22-year-old female was admitted to our hospital with nausea and vomiting of 1 day duration. Biochemical tests on admission revealed a marked increase of serum AST 19,810 IU/L, ALT 10,340 IU/L, total bilirubin 5.7 mg/dL, BUN 32.7 mg/dL and creatinine 4.4 mg/dL. Prothrombin time was prolonged to 40.3 seconds (INR 5.85). Random urine Na+ was 121.5 mmol/L and fractional excretion of sodium 22%. IgM antibody to hepatitis A virus was positive, while serology tests for hepatitis B and C virus, HIV, cytomegalovirus and Epstein-Barr virus were negative. On the 4th day of admission, hepatic encephalopathy and diuretics-resistant pulmonary edema developed. Lactulose treatment was performed for hepatic encephalopathy, and intermittent hemodialysis and continuous venovenous hemodialysis for pulmonary edema and uremia. On day 21, her urine output increased up to 1,000 cc with progressive improvement in renal function. She was discharged on day 32, with her serum creatinine of 2.0 mg/dL and total bilirubin of 4.7 mg/dL.