Frontiers in medicine · 2026
Plasma exchange and double plasma molecular adsorption system combined with continuous renal replacement therapy for hepatitis B-related liver failure complicated by stage 3 acute kidney injury: a case report.
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Zheng Ding, Li Ran, Li Xiaobin, Peng Zhaoxuan, Liu Jurong, Wang Xiaodong, Peng Mengyun, Zhu Xiaoning, Wang Jing
Аннотация
BACKGROUND: Hepatitis B virus (HBV)-related liver failure can progress rapidly to neurological and renal dysfunction. In this setting, declining aminotransferase levels may be misleading if hepatic synthetic function and extrahepatic organ function continue to deteriorate.
CASE PRESENTATION: A 27-year-old woman presented with severe fatigue, dark urine, and jaundice. Laboratory testing showed marked hepatocellular injury, coagulopathy, HBV infection markers, and an HBV DNA level of 3.57 × 10⁶ copies/mL. During hospitalization, serum aminotransferase levels declined substantially; however, bilirubin and coagulation abnormalities worsened, serum creatinine increased from 96 μmol/L on day 1 to 825 μmol/L on day 4, and the patient developed hypersomnia and impaired consciousness. The renal deterioration met criteria for stage 3 acute kidney injury. Following multidisciplinary assessment, plasma exchange combined with a double plasma molecular adsorption system was used for liver-directed extracorporeal support, while continuous renal replacement therapy was initiated primarily for severe acute kidney injury and metabolic support. Consciousness, coagulation, liver function, and renal function subsequently improved. The patient left the intensive care unit on day 7, was discharged on day 24, and maintained normal liver and kidney function during follow-up.
CONCLUSION: This case highlights that declining aminotransferase levels do not necessarily indicate clinical recovery in rapidly progressive HBV-related liver failure. Serial assessment of hepatic synthetic function, neurological status, and renal function identified continued multiorgan deterioration and guided timely, indication-based extracorporeal support. The clinical value of this case lies in the decision-making process for coordinated liver and renal support rather than in the novelty of the individual treatment modalities.
CASE PRESENTATION: A 27-year-old woman presented with severe fatigue, dark urine, and jaundice. Laboratory testing showed marked hepatocellular injury, coagulopathy, HBV infection markers, and an HBV DNA level of 3.57 × 10⁶ copies/mL. During hospitalization, serum aminotransferase levels declined substantially; however, bilirubin and coagulation abnormalities worsened, serum creatinine increased from 96 μmol/L on day 1 to 825 μmol/L on day 4, and the patient developed hypersomnia and impaired consciousness. The renal deterioration met criteria for stage 3 acute kidney injury. Following multidisciplinary assessment, plasma exchange combined with a double plasma molecular adsorption system was used for liver-directed extracorporeal support, while continuous renal replacement therapy was initiated primarily for severe acute kidney injury and metabolic support. Consciousness, coagulation, liver function, and renal function subsequently improved. The patient left the intensive care unit on day 7, was discharged on day 24, and maintained normal liver and kidney function during follow-up.
CONCLUSION: This case highlights that declining aminotransferase levels do not necessarily indicate clinical recovery in rapidly progressive HBV-related liver failure. Serial assessment of hepatic synthetic function, neurological status, and renal function identified continued multiorgan deterioration and guided timely, indication-based extracorporeal support. The clinical value of this case lies in the decision-making process for coordinated liver and renal support rather than in the novelty of the individual treatment modalities.