Fulminant meningococcemia and acute renal failure in a 3-year-old boy

Abstract

Acute renal failure is a common occurrence in sepsis, but is rarely reported in meningococcemia. We present a young child diagnosed with fulminant meningococcemia who had several poor prognostic factors, including hypotension, thrombocytopenia, purpura fulminans, seizures, the absence of meningitis with meningococcemia, and acute renal failure, which was successfully treated with peritoneal dialysis. Peritoneal dialysis was started on the 5th day because the patient had been anuric for 48 h. At that time, analysis showed that the child was both hypokalemic and hypophosphatemic. His serum blood urea nitrogen was 61 mg/dl, creatinine 2.75 mg/dl, potassium 2.8 mEq/l, and phosphorus 0.7 mg/dl. Urine output began on the 12th day post admission and normalization of serum creatinine was achieved on the 26th day. In conclusion, renal failure is an important complication of meningococcemia and, to be effective, sometimes long-term peritoneal dialysis is required. Profound metabolic abnormalities, such as hypokalemia and hypophosphatemia, may occur paradoxically in the presence of oliguria.

Renal replacement therapies in pediatric intensive care patients: Experiences of one center in Turkey

“…In adults, sepsis has been identified as the most important cause of MODS and several studies have reported greater mortality in these patients. However, a recent review of MODS and sepsis in children states that infection is the initiating stimulus in only half of MODS cases 7,8,11 . In our study, we found sepsis as the most frequent cause of ARF in PICU patients.…”

“…after abdominal surgery). Also, severe fluid overload cannot always be successfully treated by PD as well as hemodialysis (HD) 2,8–10 . Advances in vascular access techniques and pediatric age adapted equipments made HD and hemofiltration more available 1,2 .…”

Hypophosphatemia in meningococcal sepsis

“…We read with interest the article by Akil et al [1], presenting a 3-year-old boy with fulminant meningococcemia and acute renal failure. In this patient hypophosphatemia occurred paradoxically in the presence of oliguria.…”

“…In most of these studies, factors such as respiratory alkalosis, renal disease, prior intravenous fluid administration, and poor nutritional status were among the exclusion criteria or were not observed for many of the hypophosphatemic patients. The patient presented by Akil et al [1] already had low serum phosphate (1.68 mg/dl) on admission, with normal blood urea nitrogen and creatinine levels (6 mg/dl and 0.27 mg/dl, respectively) [1]. So, what is the cause of hypophosphatemia in patients with acute infection?…”

“…These findings were in agreement with those of Barak et al [6], since TNF-a and IL-6 are the main stimuli for the production of CRP from hepatocytes, and their peak levels in plasma precede those of CRP by 24-48 h. Consequently, the hypophosphatemia in the presented case of meningococcal sepsis could be attributed to the overproduction of cytokines such as TNF-a and IL-6, which are known to play a major role in the pathogenesis of sepsis. Notably, the patient's CRP level on admission was very high (245 mg/l) [1].…”