Male patient, 42 years old, drinker of more than 100 g of ethanol a day, without other backgrounds of interest, who complained of 3 days of evolution (coincidence with an increase in the usual consumption of alcohol).
Physical examination revealed mucocutaneous jaundice, encephalopathy grade I and ascites.
There was no increase in liver or spleen.
Cardiorespiratory auscultation was normal.
On admission laboratory tests, the following results were obtained: leukocytes 26,820 per μl (neutrophils, 77%), prothrombin activity 40%, plasma creatinine 152 mg/dl, ALT 103 mg/dl, total bilirubin
The chest X-ray showed a right basal alveolar infiltrate and the abdominal ultrasound showed a small liver with increased echogenicity and homogeneous structure; a permeable portal vein, normal biliary stricture, abundant ascites.
Abdominal computed tomography (CT) revealed a small, lobulated contour liver.
With the clinical judgment of acute alcoholic hepatitis on chronic liver disease with severity criteria and Maddrey score of 71 entered the digestive service.
Treatment with corticosteroids, enteral nutrition and empirical antibiotic therapy was established.
On the fifth day of hospital stay, hepatic encephalopathy progressed to grade III and acute renal failure persisted in the context of hepatorenal syndrome type I. Laboratory tests showed a worsening of renal function with elevated urea/dl levels of total bilirubin 4.19
Pentoxyphylline (as anti-TNF therapy), terlipressin and albumin (as treatment for SHR type I) and MARS are added to the treatment upon request of informed consent.
Three sessions were held every other day, with the patient being admitted to the Intensive Care Unit (ICU) for each session.
The approximate duration of each session was 12 hours or until filter clotting.
Femoral venous access was used exclusively for this purpose.
The associated renal replacement technique was continuous venovenous HDF.
Anticoagulation was variable with sodium epoprostenol 5 ng/kg/minute, with heparin Na 5U/kg/hour or both.
The patient was hemodynamically stable during the sessions, with no remarkable incidences.
