No abstract

The detection of IgG and IgM anti-cytomegalovirus is very important when movements of serum transaminases are noted in absence of positivity for virus of hepatitis in uremic patients on substitutive treatment; in our patients, we have noted a positivity of 67% for the IgG class. Cytomegalic infection must be taken into consideration for the high parenteral transmissibility in addition to the high grade of immunodepression of uremic patients.

Introduction Acute liver failure (ALF) is a rare syndrome defined by the rapid loss of liver function in the absence of pre‐existing liver disease, which may be secondary to hepatitis A virus, hepatitis E virus (HEV), or to drugs in about 50% of cases. Extracorporeal albumin dialysis enables the elimination of albumin‐bound toxins that accumulate in liver failure. Methods We report a case of ALF secondary to HEV associated with severe hyperbilirubinemia. Patient was treated with four consecutive sessions of single‐pass albumin dialysis (SPAD) carried out setting the following parameters: time: 300 min, Qb: 60 mL/min, Qd: 800–1000 mL/min, dialysate containing 4% albumin, citrate: 3–4 mmol/L. Result SPAD documented good support of liver function. Bilirubin levels were reduced from 22 to 14 g/dL after four treatments. Pruritus was the first clinical sign of improvement. Conclusion SPAD system can represent a safe and effective therapeutic option.

I disturbi dell'equilibrio idro-salino risultano estremamente comuni nei pazienti ospedalizzati, in particolar modo in quelli critici. L'ipernatremia, che può essere secondaria a sovraccarico di sodio o a perdita di fluidi ipotonici, può contribuire significativamente alla già importante morbilità e al rischio di morte di questa categoria di pazienti. Questo disturbo richiede pertanto una diagnosi tempestiva e può essere corretto con un intervento appropriato e con il trattamento dei fattori predisponenti che ne sono alla base.