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Use of drotrecorgin alfa – recombinant activated human protein C in treatment of septic shock in the course of therapy for nephrolithiasis

Jadwiga Biernacka, Jarosław Wośko, Wojciech Dąbrowski, Andrzej Nestorowicz

Med Sci Monit 2003; 9(5): CS25-28

ID: 11079

Available online: 2003-05-22

Published: 2003-05-22

Background: Septic shock is the most dangerous complication of nephrolithiasis management utilizing percutaneous methods.
Case report: The patient, D.M., aged 60 was subjected to scheduled percutaneous nephrolithotomy due to coral calculosis of the pyelocalyceal system. As pyuria was noted intraoperatively, nephrostomy was left after the procedure. Over ten hours after the surgery the patient developed the symptoms of severe septic shock with progressive respiratory distress, renal failure, intravascular
coagulation syndrome and impaired consciousness. Nephrectomy was performed, antibiotic treatment and high doses of norepinephrine instituted. Hemodynamic stabilization was obtained, without, however, marked improvement of the patient’s condition. Because of
persistent coagulation disorders and multiorgan dysfunction, recombinant activated protein C preparation – drotrecorgin alfa (Xigris Eli Lilly) was added to the therapeutic regimen. From
the second day of infusion, systematic improvement of the coagulation system parameters was observed, making it possible to reduce the doses of catecholamines, oxygen concentration in
the gas mixture used for ventilation, as well as stabilization of the function of the preserved kidney. The patient was weaned off the respirator on the 8th day of treatment and on the 13th
day referred to the Urology Department, from which she was soon discharged home.
Conclusions: 1. Surgical resection of the infection source and cause of the septic shock is the prerequisite for successful pharmacological treatment.
2. Administration of rh-APC to a patient meeting the PROWESS criteria may be an effective and safe method of treatment in the complex management of septic shock.

Keywords: Disseminated Intravascular Coagulation - blood, Disseminated Intravascular Coagulation - drug therapy, Disseminated Intravascular Coagulation - etiology, Kidney Calculi - complications, Kidney Calculi - therapy, Nephrectomy, Nephrostomy, Percutaneous - adverse effects, Protein C - therapeutic use, Recombinant Proteins - therapeutic use, Shock, Septic - blood, Shock, Septic - drug therapy, Shock, Septic - etiology, Staphylococcal Infections - blood, Staphylococcal Infections - drug therapy, Staphylococcal Infections - etiology, Staphylococcus haemolyticus