Successful treatment of acute kidney injury secondary to haeme nephropathy in paroxysmal nocturnal haemoglobinuria with alkaline diuresis

Abstract

Paroxysmal nocturnal haemoglobinuria (PNH) also known as ‘Marchiafava Micheli syn-drome’ is a rare condition which can lead to both acute and chronic forms of renal failure through renal tubular haemosiderin deposition. A 45-year-old lady with underlying PNH, pre-sented with complaints of fever, productive cough followed by dark coloured urine. Investiga-tions revealed pancytopenia with a markedly raised creatinine from her baseline (from 65 mmol/L to 385 mmol/L) consistent with acute kidney injury (AKI). Renal biopsy con-firmed the diagnosis of haeme nephropathy. The renal impairment improved rapidly and nor-malised over a period of 5 days with alkaline diuresis (AD). The patient did not require hae-modialysis unlike most other reported cases of AKI secondary to haeme nephropathy in PNH. This is the second reported case of AKI in PNH which was successfully treated with AD alone emphasizing the role of AD as a promising therapeutic strategy in this condition.