A case of acute renal failure requiring blood purification after status epilepticus

Background

The prognosis for patients with status epilepticus (SE) can be poor because of various organ dysfunctions including renal complications such as acute kidney injury caused by rhabdomyolysis, acute renal failure with loin pain and patchy renal ischemia after anaerobic exercise, and acute uric acid nephropathy. We report a case of acute renal failure requiring hemodiafiltration (HDF) after SE.

Case presentation

The patient was a 20-year-old man with intractable focal epilepsy. He was treated with zonisamide, clobazam, lamotrigine, lacosamide, and topiramate. SE occurred suddenly after he had breakfast. When he arrived at our hospital, his SE had ceased and he had a decreased level of consciousness. His respiratory sounds were weak and gasping breaths were noted. Blood examination tests showed marked metabolic acidosis, hyperlactatemia, elevated creatinine, and hypokalemia. Because his uric acid level increased to 24.0 and he had become anuric, he was started on HDF. The cause of acute renal failure was thought to be acute uric acid nephropathy. Three days after the start of HDF, urination started. HDF was terminated on the 7th day and he was discharged from hospital on the 42nd day.

Conclusion

Young adult men with greater muscle mass may experience increased nucleotide breakdown during seizures, raising serum uric acid levels, and potentially leading to a risk of acute uric acid nephropathy. Because there is a risk of serious organ damage including acute renal failure such as acute uric acid nephropathy after SE, a patient's general condition after SE should be monitored carefully.