Ps-R05-6: A Case of Acute Kidney Injury With Thrombotic Microangiopathy Caused by Malignant Hypertension

Abstract

require lower-extremity amputation. LDL-apheresis has been initiated as a supportive treatment for patients with chronic limb-threatening ischemia (CLTI), especially in cases where revascularization by endovascular therapy (EVT) is not sufficiently effective. In 2021, a new adsorption-type blood purification device, Rheocana, that can selectively remove LDL-C and fibrinogen, was developed. In a clinical trial, 45.9% of the ulcers were healed using Rheocana. Since then, it has been widely used for dialysis patients with CLTI in Japan; however, hypotension during LDLapheresis is still a major adverse event.Design and Methods: Case report.Results: An 83-year-old Japanese man presented with a right leg ulcer. He had started undergoing hemodialysis 3 years prior because of diabetic kidney disease. CLTI was recognized 6 months prior, and repeated EVT was ineffective and failed to improve the ulcer. His blood pressure was 129/71 mmHg and antihypertensive agents were not used. LDL-apheresis with Rheocana was initiated; however, his systolic blood pressure decreased to 60 mmHg, and LDL-apheresis was stopped immediately. After discontinuing LDL-apheresis, the his blood pressure recovered. Anticoagulants were changed from heparin to nafamostat mesylate, and LDL-apheresis was restarted. His blood pressure did not decrease after anticoagulation therapy, and his leg ulcer was successfully healed.