Acute renal failure associated with the thrombocytopenia of septicemia

Gram-negative sepsis is a recognized cause of thrombocytopenia and has recently been associated with acute renal failure from acute glomerulonephritis. We report here a patient in which the development of and treatment for trauma, gram-negative sepsis, was followed one day later by rapidly rising WBC (20,000-65,000), creatinine, BUN, and thrombocytopenia (300,000-25,000). Peak creatinine (6.5 mg%) and BUN (160 mg%) levels occurred on the third day of septicemia, when dialysis was begun. During the profound thrombocytopenia (less than 20,000 on days three through five of the septicemia) platelet transfusions did not raise the platelet count. The platelets returned to above 100,000 by day seven of the septicemia and the WBC was under 30,000 by this time. We propose that septicemia caused by E. coli (and staph) was responsible for the concomitant appearance of both thrombocytopenia and acute renal failure in a 20-year-old man.