The hemolytic-uremic syndrome

Gianantonio, Carlos A.; Vitacco, Margarita; Mendilaharzu, Fernando; Gallo, Guillermo

doi:10.1016/s0022-3476(68)80427-5

Cited by 136 publications

(83 citation statements)

References 9 publications

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“…Oligoanuria or its duration during HUS is associated with worse outcomes [6][7][8][9][10][11][12][13][14] and should be avoided. 15 At our institutions, we encourage starting intravenous isotonic volume expansion as early as possible in E coli O157:H7 infections, even before culture results are known.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Oligoanuric renal failure during HUS usually necessitates dialysis and lengthens hospitalization; its occurrence and duration are risk factors for chronic sequelae. [6][7][8][9][10][11][12][13][14][15] Ideally, the oligoanuric form of HUS should be prevented, because oligoanuria seems to represent a more severe form of renal injury.Vascular injury and prothrombotic coagulation abnormalities, such as thrombin generation, fibrinolysis inhibition, intravascular fibrin accretion, 3 elevated circulating platelet activating factor, 16 and degraded von Willebrand factor multimers, 17 precede renal injury in infected children. These findings suggest that vascular occlusion, a process that conceivably could be attenuated by volume expansion, at least partly underlies renal insufficiency during HUS.…”

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Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

et al. 2005

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ABSTRACT. Objective. The hemolytic uremic syndrome (HUS) consists of hemolytic anemia, thrombocytopenia, and renal failure. HUS is often precipitated by gastrointestinal infection with Shiga toxin-producing Escherichia coli and is characterized by a variety of prothrombotic host abnormalities. In much of the world, E coli O157:H7 is the major cause of HUS. HUS can be categorized as either oligoanuric (which probably signifies acute tubular necrosis) or nonoligoanuric. Children with oligoanuric renal failure during HUS generally require dialysis, have more complicated courses, and are probably at increased risk for chronic sequelae than are children who experience nonoligoanuric HUS. Oligoanuric HUS should be avoided, if possible. The presentation to medical care of a child with definite or possible E coli O157:H7 infections but before HUS ensues affords a potential opportunity to ameliorate the course of the subsequent renal failure. However, it is not known whether events that occur early in E coli O157:H7 infections, particularly measures to expand circulating volume, affect the likelihood of experiencing oligoanuric HUS if renal failure develops. We attempted to assess whether pre-HUS interventions and events, especially the volume and sodium content of intravenous fluids administered early in illness, affect the risk for developing oligoanuric HUS after E coli O157:H7 infections.Methods. We performed a prospective cohort study of 29 children with HUS that was confirmed microbiologically to be caused by E coli O157:H7. Infected children were enrolled when they presented with acute bloody diarrhea or as contacts of patients who were known to be infected with E coli O157:H7, or if they had cultureconfirmed infection, or if they presented with HUS. HUS was defined as hemolytic anemia (hematocrit <30%, with fragmented erythrocytes on peripheral-blood smear), thrombocytopenia (platelet count of <150 000/mm 3 ), and renal insufficiency (serum creatinine concentration that exceeded the upper limit of normal for age). A wide range of pre-HUS variables, including demographic factors, clinical history, medications given, initial laboratory values, and volume and content of parenteral fluid administered, were recorded and entered into analysis. Estimates of odds ratios were adjusted for possible confounding effects using logistic regression analysis. Twenty-nine children who were <10 years old, had HUS confirmed to be caused by E coli O157:H7, and were hospitalized at the Children's Hospital and Regional Medical Center, Seattle, were studied. The main outcome measured was development of oligoanuric renal failure. Oligoanuria was defined as a urine output <0.5 mL/kg per hour for at least 24 consecutive hours.Results. As a group, the children with oligoanuric renal failure presented to medical attention and were evaluated with laboratory testing later than the children with nonoligoanuric renal failure. On initial assessments, the children with oligoanuric outcomes had higher white blood cell counts, lower platelet counts...

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Section: Discussionmentioning

confidence: 99%

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Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

et al. 2005

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“…So, a strong suspicion on the background of such situations for non-oliguric ARF is essential to make the clinician to do biochemical evaluation periodically and for early detection of non-oliguric or high output ARF. 1 With the present available knowledge, it is clearly understood that to monitor renal function, it is important to use biochemical studies as well as measurement of urine volume which will help us not to miss non-oliguric renal failure.…”

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Outcome of acute renal failure in children in Chennai, India

Kalyanasundaram

Elangovan

Sailavasan

2017

Int J Contemp Pediatr

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Background: Acute Renal Failure (ARF) is one of the common causes of morbidity and mortality in children. With the availability of increasing knowledge and awareness, dialysis facilities and excellent supportive treatment, the overall outcome is changing. This study is undertaken to find out the outcome of ARF in children.Methods: This prospective cross-sectional study was done in Institute of Child Health and Hospital for Children, (ICH and HC) Egmore, Chennai from February 2014 to January 2016. Children with elevated blood urea (>40 mgs/dl) and serum creatinine (>1 mg/dl) were included and evaluated for etiology, treatment modality and outcome and other co-morbid features. Data was analysed on SPSS 20.0. P value of <0.05 was considered significant.Results: A total of 105 children (65 boys, 40 girls) from newborn period to 12 years were examined. The common age of presentation of ARF is 1-4 years with a male preponderance and acute glomerulonephritis were found to be commonest cause. There was no statistically significant difference in mortality in relation to age group (P 0.98). There was a statistically significant difference in mortality in relation to duration of oliguria (P 0.02), Serum creatinine levels (P 0.03). The role of other biochemical values like serum potassium (P 0.14), serum bicarbonate (P 0.59) were not found statistically significant. Peritoneal dialysis in general improves survival, but it is not statistically significant (P 0.33). Systemic complications associated with ARF increases mortality and it is statistically significant (Chi- square value = 9.13, P = 0.003).Conclusions: ARF in children is due to transient disorders and early referral to major centres even with 1-2 days oliguria and early treatment will improve the prognosis. Peritoneal dialysis in severe ARF with associated complications really helped the children.

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“…It was described also that patients with clinical diagnosis of HUS can manifest with neurologic involvement, and a high percentage of patients, classified as having TTP, had renal failure. Moreover, individual patients have been reported as having HUS in one episode and TTP during another [11][12][13][14][15][16].…”

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Thrombotic Microangiopathy-Kidneys and Beyond: Historic Lessons

Zakharova¹

2017

UNOAJ

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The hemolytic-uremic syndrome

Cited by 136 publications

References 9 publications

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

Outcome of acute renal failure in children in Chennai, India

Thrombotic Microangiopathy-Kidneys and Beyond: Historic Lessons

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