Diagnosis is confirmed by low level of ADAMTS-13 activity. This case report describes the occurrence TTP in end stage renal disease (ESRD) patient undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: A 79 year old Thai female presented with watery diarrhea and alteration of consciousness 1 day before admission. She had history of ESRD due to hypertension and was started on CAPD 3 months ago. Her medications include calcium carbonate,
furosemide, folic acid, metoprolol, Cell Cycle inhibitor amlodipine, simvastatin, elixir KCl and Epoein alfa. Physical examination revealed an old female with drowsiness, no focal neurological deficit. Laboratory examination revealed Hb10.4 g/dL Hct 31% WBC 19,450 PMN 92% lymphocyte 8% platelet 73,000/mm3, >1% of schiztocytosis was noted in peripheral blood smear. LDH level was elevated at 645 U/L (normal 125–220 U/L), her coagulogram was normal, tests for anti-HIV and ANA were negative. Stool examination revealed watery, yellowish stool, no mucous, WBC 0-1, RBC 0-1,
stool culture and hemoculture were negative. CT brain found Talazoparib datasheet no significant abnormality. Serum ADAMTS13 activity was decreased at 15% (normal 58–170%), ADAMTS13 inhibitor was negative. She was treated by plasma infusion 30 ml/kg/day (1) for 2 consecutive days and then started on daily plasma exchange with 1 plasma volume(2) for 3 sessions. Results: After plasma exchange, her platelet count increased and LDH return to normal and regains better consciousness. Two weeks after discharge, she had good consciousness and normal platelet count. Conclusion: We report
the first case of idiopathic TTP confirmed by low ADAMTS13 activity in ESRD patient, successfully treated by plasma infusion and plasma exchange. TAKAHASHI KEIKO1, KOBAYASHI TAKASHI1, SUZUKI YUSUKE1, MEIZI LIU2, SUGAYA TAKESHI1,3, HORIKOSHI SATOSHI1, URABE TAKAO2, TOMINO YASUHIKO1 1Nephrology, Juntendo University Faculty of Medicine; 2Neurology, Juntendo Univetsity Faculty of Medicine; 3CMIC Co., Ltd Introduction: Renal lipid metabolism has been discussed triclocarban in many renal diseases. Recent studies revealed the renal metabolism after lipid-overloading in glomerular failure or in acute renal vascular injury such as renal ischemic reperfusion. In addition, it is recently known that such lipid-metabolism may importantly contribute to the progression of renal injury. L-type fatty acid binding protein (L-FABP) is known as a sensitive biomarker for many renal diseases. L-FABP is expressed in human proximal tubules and may play an important role in fatty acid homeostasis in kidneys. L-FABP has high affinity and function to bind free fatty acid. Therefore, L-FABP may has the potential function as an endogenous antioxidant.