ESPN 51th Annual Meeting

ESPN 2018


 
COLCHICINE PROVED IMPRESSIVELY SUCCESSFUL FOR THE TREATMENT OF AKI DUE TO THIRD SPACE FLUID ACCUMULATION
Licia Peruzzi 1 Roberta Camilla 1 Francesca Mattozzi 1 Enrico Cocchi 1 Roberto Bonaudo 1 Bruno Gianoglio 1 Roberto Bordese 3 Luca Deorsola 2 Carlo Pace Napoleone 2 Fabio Timeus 4 Franca Fagioli 4

1- NEPHROLOGY DIALYSIS TRANSPLANT, R MARGHERITA CHILDREN HOSPITAL TURIN ITALY
2- CARDIOSURGERY, R MARGHERITA CHILDREN HOSPITAL TURIN ITALY
3- CARDIOLOGY, R MARGHERITA CHILDREN HOSPITAL, TURIN, ITALY
4- ONCOLOGY, R. MARGHERITA CHILDREN HOSPITAL, TURIN, ITALY
 
Introduction:

Colchicine is a tricyclic alkaloid used in inflammatory diseases including gout, vasculitis as Behçet syndrome, familial Mediterranean fever, and postpericardiotomy syndrome. We used it as a rescue therapy in two complicated cases of acute kidney injury (AKI), targeting the inflammatory status that caused refractory third space protein and fluid leakage, resistant to any other treatment.

Material and methods:

Two pediatric patients presenting with renal failure secondary to third space fluid accumulation were treated with colchicine at the starting dose of 15 and 10 micrograms/kg respectively for 2 days, then tapered to 7.5 and 5 micrograms/kg.

Results:

Patient n°1 is a male with univentricular heart disease, palliated with Fontan operation at 3 years of age. As a consequence of Fontan circulation he developed plastic bronchitis, portal hypertension and protein losing enteropathy. At the age of 17 he underwent heart transplantation, complicated by fluid and protein third space accumulation (ascitis, pleural and mediastinic lymphatic effusion) due to impaired lymphatic circulation in spite of a succesful transplant and thoracic duct ligation. Lymphatic extravasation was so severe to cause AKI requiring CRRT for 3 months. After several treatments and hypolipidic diet he started colchicine at day 93 after transplant, with immediate reduction of pleural effusion and ascitis, resulting in dramatic improvement of renal function and diuresis repraisal allowing for dialysis discontinuation within 10 days. He is currently still on colchicine 5 micrograms/kg/day without any side effect. eGFR is 35 ml/min/1.73m2. 

Patient n° 2 is a 12 years old girl, with trisomy 21 and a history of acute myeloid leukemia at 4 years of age, successfully treated. At the age of 11 she had acute lymphoblastic leukemia and required allogeneic hematopoietic stem cell transplantation. A year after transplantation she developed polyserositis with ascitis and pleural effusion, determining pre-renal AKI requiring CRRT. She showed complete resolution of pleural effusion within 5 days from the beginning of colchicine, allowing for pleural drainage removal and rapid improvement of the hemodynamic conditions, leading to dialysis discontinuation and normalization of renal function. Colchicine was discontinued after 7 days for transient leucopenia and no other side effects were experienced.

No gastrointestinal side effects were observed in our patients.

 

Conclusions:

 

Colchicine could be a good therapeutic option in refractory third space fluid losses leading to AKI. Further studies are needed to confirm this encouraging result in such complex cases.