Thrombotic microangiopathy: an atypical cause of acute renal failure in patients with acute pancreatitis

Objective. To report on the development and treatment of thrombotic microangiopathy, an atypical cause of acute renal failure in patients with acute pancreatitis. Design. Case reports. Setting. A 21-bed medical intensive care unit at an university hospital. Patients. Two men with acute pancreatitis presented with acute renal failure, neurological manifestations, haemolytic anaemia and thrombocytopenia. Both patients required intensive care. Measurements. Fragmented red cell count; levels of haptoglobin, amylase and lipase; serological testing for Escherichia Coli O157; computed tomography of the abdomen. Main results. The patients' courses were rapidly favourable after daily plasma exchange. A review of the existing medical literature was also undertaken. Conclusion. As thrombotic microangiopathy may be life-threatening without administration of fresh frozen plasma or plasma exchange, physicians should consider this disease as a possible cause of acute renal failure in patients with acute pancreatitis.