Hemolytic-Uremic Syndrome: Current Concepts and Management

Fong, Jack S. C.; Chadarévian, Jean‐Pierre de; Kaplan, Bernard S.

doi:10.1016/s0031-3955(16)34216-x

Cited by 173 publications

(77 citation statements)

References 97 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to Dolislager and Tune in 1978 [12] gastroenteritis pro-droma was most common in our series. Despite early initation of dialysis, 30% died which was high compared with the current mortality rate of 5% to 10% [13]. Among the factors that contributed to this high mortality was the late referral from the local hospitals.…”

Section: Discussionmentioning

confidence: 91%

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

et al. 1992

View full text Add to dashboard Cite

One hundred children with acute renal failure (ARF) were admitted in our Nephrology Unit, Maternity & Children's Hospital over a four year period. Male patients outnumbered females with a ratio of 3:2. The ages of patients ranged from 1 month to 13 years with a mean age of 3.9 years. Fifty-five were suffering from intrinsic renal factors, 32 from post-renal and 13 were due to pre-renal factors. Among the intrinsic renal causes: acute glomerulonephritis (27 patients) and hemolytic-uremic syndrome (15 patients) were most common. Posterior urethral valve (20 patients) was the leading cause of post-renal failure. All pre-renal failure was due to diarrheal disease. Forty patients with ARF required dialysis (23 peritoneal dialysis, 17 hemodialysis). The remaining 60 patients were treated conservatively. The outcome in our patients were as follows: 60% cured, 29% continued to have variable degrees of renal failure and only 11% died. The latter was due to sepsis and cardiorespiratory failure. Acute renal failure (ARF) is not uncommon in children. The incidence varies from 4-22 per million population [1]. Intrinsic renal failure is the leading cause of ARF in developed countries [2], whereas pre-renal failure due to renal hypoperfusion is the leading cause of ARF in developing countries [3]. Post-renal failure occurs usually due to obstructive uropathy reported in 2% to 15% of children with ARF [4].No data are available from the Kingdom of Saudi Arabia regarding children presenting with ARF. We conducted this study in order to analyze the etiological factors, clinical presentation, response to the different modes of treatment and the outcome in 100 children admitted to our renal unit with this condition. Methods and MaterialsThe study included 100 children with ARF referred to our unit from different parts of the Kingdom over a period of four years. Children less than one-month-old were excluded from the study as the pattern of disease is different at this age.Acute renal failure was defined as a reduction in glomerular filtration rate "GFR" as manifested by oliguria (urine volume less than 300 ml/M2/day) or anuria (urine volume less than 1 ml/kg/day) and niore than 50% decrease in renal function as measured by serum creatinine (i.e. > 160 μmοΙ/L). Patients with normal urine output and increasing blood urea and serum creatinine were defined as having non-oliguric renal failure and included in this study [5].Pre-renal failure was diagnosed if the urine osmolality was more than 500 mosmol/L, urine urea to plasma urea concentration ratio more than five, fractional excretion of sodium "FeNa" less than 1% [6]. In cases we doubted a fluid challenge of 20 ml/kg of dextrose saline was given in order to differentiate between pre-renal and intrinsic renal failure. Initial diagnosis of post-renal failure was made by renal ultrasonography which was done routinely on all cases. Other investigations done at different stages of illness include renal isotope scan, micturating cystogram and transurethral endoscopy. Renal biopsy was done ...

show abstract

Section: Discussionmentioning

confidence: 91%

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

et al. 1992

View full text Add to dashboard Cite

show abstract

“…The diagnosis of HUS was based on the presence of microangiopathic hemolytic anemia (hemoglobin Ͻ 10 g/dl) with thrombocytopenia (platelets Ͻ 150/nl) and acute nephropathy (serum creatinine above the upper limit for age) according to the criteria of Fong et al (13 (ii) Household contacts. Household contacts were defined as persons who lived in the same household or visited the family frequently around the time of the diarrhea of the index child.…”

Section: Subjects Studied (I) Hus Patientsmentioning

confidence: 99%

Shiga Toxin-Producing Escherichia coli Infection and Antibodies against Stx2 and Stx1 in Household Contacts of Children with Enteropathic Hemolytic-Uremic Syndrome

et al. 2002

View full text Add to dashboard Cite

“…In 1983 and 1985, studies from Canada (80,81) showed a close association between VTEC infection and the classical form of HUS, which is a leading cause of acute renal failure in childhood. HUS (42,51,(54)(55)(56)76) is defined by a triad of features: acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. In the classical form of the syndrome, which is by far the most common, these features develop a few days after an acute, usually bloody, diarrheal illness which shows marked similarities, clinicopathologically (156) and radiologically (5,88,159,170), to hemorrhagic colitis.…”

mentioning

confidence: 99%

Infection by verocytotoxin-producing Escherichia coli

1989

View full text Add to dashboard Cite

Verocytotoxin (VT)-producing Escherichia coli (VTEC) are a newly recognized group of enteric pathogens which are increasingly being recognized as common causes of diarrhea in some geographic settings. Outbreak studies indicate that most patients with VTEC infection develop mild uncomplicated diarrhea. However, a significant risk of two serious and potentially life-threatening complications, hemorrhagic colitis and the hemolytic uremic syndrome, makes VTEC infection a public health problem of serious concern. The main reservoirs of VTEC appear to be the intestinal tracts of animals, and foods of animal (especially bovine) origin are probably the principal sources for human infection. The term VT refers to a family of subunit exotoxins with high biological activity. Individual VTEC strains elaborate one or both of at least two serologically distinct, bacteriophage-mediated VTs (VT1 and VT2) which are closely related to Shiga toxin and are thus also referred to as Shiga-like toxins. The holotoxins bind to cells, via their B subunits, to a specific receptor which is probably the glycolipid, globotriosyl ceramide (Gb3). Binding is followed by internalization of the A subunit, which, after it is proteolytically nicked and reduced to the A1 fragment, inhibits protein synthesis in mammalian cells by inactivating 60S ribosomal subunits through selective structural modification of 28S ribosomal ribonucleic acid. The mechanism of VTEC diarrhea is still controversial, and the relative roles of locally acting VT and "attaching and effacing adherence" of VTEC to the mucosa have yet to be resolved. There is increasing evidence that hemolytic uremic syndrome and possibly hemorrhagic colitis result from the systemic action of VT on vascular endothelial cells. The role of antitoxic immunity in preventing the systemic complications of VTEC infection is being explored. Antibiotics appear to be contraindicated in the treatment of VTEC infection. The most common VTEC serotype associated with human disease is O157:H7, but over 50 different VT-positive O:H serotypes have now been identified. The best strategies for diagnosing human VTEC infection include testing for the presence of free VT in fecal filtrates and examining fecal cultures for VTEC by means of deoxyribonucleic acid probes that specify genes encoding VT1 and VT2. Both methods are currently confined to specialized laboratories and await commercial development for wider use. In the meantime, most laboratories should continue to screen for the most common human VTEC serotype, O157:H7, using a sorbitol-containing MacConkey medium.

show abstract

Hemolytic-Uremic Syndrome: Current Concepts and Management

Cited by 173 publications

References 97 publications

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

Shiga Toxin-Producing Escherichia coli Infection and Antibodies against Stx2 and Stx1 in Household Contacts of Children with Enteropathic Hemolytic-Uremic Syndrome

Infection by verocytotoxin-producing Escherichia coli

Contact Info

Product

Resources

About