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Kinoshita G, Ito-Masui A, Kato T, Okuno F, Ikejiri K, Ishikura K, Suzuki K. Veno-venous extracorporeal membrane oxygenation in managing acute respiratory distress syndrome associated with hemolytic uremic syndrome and septic shock: a case report. J Artif Organs 2024:10.1007/s10047-024-01457-9. [PMID: 38916825 DOI: 10.1007/s10047-024-01457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/07/2024] [Indexed: 06/26/2024]
Abstract
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a rescue therapy for severe respiratory failure in which conventional mechanical ventilation therapy is unsuccessful. Hemolysis during VV-ECMO support arises from multiple factors associated with organ damage and poor outcomes. Therefore, close and prompt monitoring is needed. Hemolytic uremic syndrome (HUS) is characterized by hemolysis, acute renal failure, and thrombocytopenia. Hemolytic features of the disease may complicate VV-ECMO management. A 26-year-old man with a history of cerebral palsy underwent VV-ECMO for acute respiratory distress syndrome (ARDS) due to septic shock caused by bacterial translocation during treatment for HUS. He showed features of hemolysis, with elevated lactate dehydrogenase (LDH), fragmented red blood cells, and low haptoglobin levels. Plasma free hemoglobin was measured daily throughout the whole course of ECMO with levels higher than 10 mg/dL but not exceeding 50 mg/dL. The extracorporeal membrane oxygenation (ECMO) circuit pressures were carefully monitored to ensure the pump generated no excessive negative pressure. The patient was weaned off ECMO on the eleventh day. There have been several cases of VA-ECMO in patients with HUS; however, there is limited literature on VV-ECMO. As the days on VV-ECMO tend to be longer than those on VA-ECMO, features of hemolysis may complicate management. Although HUS did not directly influence the clinical course in the present case, features of hemolysis were continuously observed. This case highlighted the importance of standard ECMO monitoring, especially daily measurement of plasma free hemoglobin.
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Affiliation(s)
- Genta Kinoshita
- Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Asami Ito-Masui
- Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Takafumi Kato
- Department of Clinical Engineering, Mie University Hospital, Tsu City, Mie, Japan
| | - Fumito Okuno
- Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Kaoru Ikejiri
- Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Ken Ishikura
- Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Neu C, Wissuwa B, Thiemermann C, Coldewey SM. Cardiovascular impairment in Shiga-toxin-2-induced experimental hemolytic-uremic syndrome: a pilot study. Front Immunol 2023; 14:1252818. [PMID: 37809105 PMCID: PMC10556238 DOI: 10.3389/fimmu.2023.1252818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Hemolytic-uremic syndrome (HUS) can occur as a systemic complication of infection with Shiga toxin (Stx)-producing Escherichia coli (STEC). Most well-known aspects of the pathophysiology are secondary to microthrombotic kidney disease including hemolytic anemia and thrombocytopenia. However, extrarenal manifestations, such as cardiac impairment, have also been reported. We have investigated whether these cardiac abnormalities can be reproduced in a murine animal model, in which administration of Stx, the main virulence factor of STEC, is used to induce HUS. Methods Mice received either one high or multiple low doses of Stx to simulate the (clinically well-known) different disease courses. Cardiac function was evaluated by echocardiography and analyses of biomarkers in the plasma (troponin I and brain natriuretic peptide). Results All Stx-challenged mice showed reduced cardiac output and depletion of intravascular volume indicated by a reduced end-diastolic volume and a higher hematocrit. Some mice exhibited myocardial injury (measured as increases in cTNI levels). A subset of mice challenged with either dosage regimen showed hyperkalemia with typical electrocardiographic abnormalities. Discussion Myocardial injury, intravascular volume depletion, reduced cardiac output, and arrhythmias as a consequence of hyperkalemia may be prognosis-relevant disease manifestations of HUS, the significance of which should be further investigated in future preclinical and clinical studies.
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Affiliation(s)
- Charles Neu
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Septomics Research Center, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Bianka Wissuwa
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Septomics Research Center, Jena University Hospital, Jena, Germany
| | - Christoph Thiemermann
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sina M. Coldewey
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Septomics Research Center, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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3
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Liboiron M, Malone MP, Brown CC, Prodhan P. Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0042-1758478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AbstractHemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors (p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement (p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.
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Affiliation(s)
- Mireille Liboiron
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Matthew P. Malone
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Clare C. Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Parthak Prodhan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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Tanné C, Javouhey E, Boyer O, Recher M, Allain-Launay E, Monet-Didailler C, Rouset-Rouvière C, Ryckewaert A, Nobili F, Gindre FA, Rambaud J, Duncan A, Berthiller J, Bacchetta J, Sellier-Leclerc AL. Cardiac involvement in pediatric hemolytic uremic syndrome. Pediatr Nephrol 2022; 37:3215-3221. [PMID: 35286451 DOI: 10.1007/s00467-022-05427-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cardiac involvement is a known but rare complication of pediatric hemolytic uremic syndrome (HUS). We conducted a nationwide observational, retrospective case-control study describing factors associated with the occurrence of myocarditis among HUS patients. METHODS Cases were defined as hospitalized children affected by any form of HUS with co-existent myocarditis in 8 French Pediatric Intensive Care Units (PICU) between January 2007 and December 2018. Control subjects were children, consecutively admitted with any form of HUS without coexistent myocarditis, at a single PICU in Lyon, France, during the same time period. RESULTS A total of 20 cases of myocarditis were reported among 8 PICUs, with a mean age of 34.3 ± 31.9 months; 66 controls were identified. There were no differences between the two groups concerning the season and the typical, Shiga toxin-producing Escherichia coli (STEC-HUS), or atypical HUS (aHUS). Maximal leukocyte count was higher in the myocarditis group (29.1 ± 16.3G/L versus 21.0 ± 9.9G/L, p = 0.04). The median time between admission and first cardiac symptoms was of 3 days (range 0-19 days), and 4 patients displayed myocarditis at admission. The fatality rate in the myocarditis group was higher than in the control group (40.0% versus 1.5%, p < 0.001). Thirteen (65%) children from the myocarditis group received platelet transfusion compared to 19 (29%) in the control group (p = 0.03). CONCLUSION Our study confirms that myocarditis is potentially lethal and identifies higher leukocyte count and platelet transfusion as possible risk factors of myocarditis. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Corentin Tanné
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France.,Service de Pédiatrie Et Néonatalogie, Hôpitaux du Pays du Mont Blanc, Sallanches, France
| | - Etienne Javouhey
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfants, Hospices Civils of Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Centres de Référence MARHEA Et MAT, Hôpital Necker-Enfants Maladies, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut IMAGINE, INSERM U1163, Université de Paris, Paris, France
| | - Morgan Recher
- CHU Lille, Department of Paediatric Intensive Care Unit, Jeanne de Flandre Hospital, 59000, Lille, France
| | | | - Catherine Monet-Didailler
- Service de Pédiatrie, Unité de Néphrologie Pédiatrique, CHU de Bordeaux, France.,Service de Pédiatrie, Centre Hospitalier de La Côte Basque, Bayonne, France
| | | | | | | | | | - Jérôme Rambaud
- Service de Réanimation Pédiatrique Et Néonatal, Hôpital Armand-Trousseau, assistance publique des Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Anita Duncan
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France
| | - Julien Berthiller
- Service d'Epidémiologie Et de Recherche Clinique. Pôle de Santé Publique Des Hospices Civils de Lyon, Lyon, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France.,Université de Lyon, Lyon, France
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Sanders E, Brown CC, Blaszak RT, Crawford B, Prodhan P. Cardiac Manifestation among Children with Hemolytic Uremic Syndrome. J Pediatr 2021; 235:144-148.e4. [PMID: 33819463 PMCID: PMC8316308 DOI: 10.1016/j.jpeds.2021.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary objectives of the study were to describe the association between cardiac manifestations and in-hospital mortality among children with hemolytic uremic syndrome. STUDY DESIGN Using the Pediatric Health Information System database, this retrospective, multicenter, cohort study identified the first hemolytic uremic syndrome-related inpatient visit among children ≤18 years (years 2004-2018). The frequency of selected cardiac manifestations and mortality rates were calculated. Multivariate analysis identified the association of specific cardiac manifestations and the risk of in-hospital mortality. RESULTS Among 3915 patients in the analysis, 238 (6.1%) had cardiac manifestations. A majority of patients (82.8%; n = 197) had 1 cardiac condition and 17.2% (n = 41) had ≥2 cardiac conditions. The most common cardiac conditions was pericardial disease (n = 102), followed by congestive heart failure (n = 46) and cardiomyopathy/myocarditis (n = 34). The percent mortality for patients with 0, 1, or ≥2 cardiac conditions was 2.1%, 17.3%, and 19.5%, respectively. Patients with any cardiac condition had an increased odds of mortality (OR, 9.74; P = .0001). In additional models, the presence of ≥2 cardiac conditions (OR, 9.90; P < .001), cardiac arrest (OR, 38.25; P < .001), or extracorporeal membrane oxygenation deployment (OR, 11.61; P < .001) were associated with increased risk of in-hospital mortality. CONCLUSIONS This study identified differences in in-hospital mortality based on the type of cardiac manifestations, with increased risk observed for patients with multiple cardiac involvement, cardiac arrest, and extracorporeal membrane oxygenation deployments.
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Affiliation(s)
- Emily Sanders
- Pediatrics, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Clare C. Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard T Blaszak
- Nephrology; Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Brendan Crawford
- Nephrology; Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Parthak Prodhan
- Pediatric Cardiology/Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas
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Yesilbas O, Yozgat CY, Akinci N, Sonmez S, Tekin E, Talebazadeh F, Jafarov U, Temur HO, Yozgat Y. Acute Myocarditis and Eculizumab Caused Severe Cholestasis in a 17-Month-Old Child Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli. J Pediatr Intensive Care 2020; 10:216-220. [PMID: 34395040 DOI: 10.1055/s-0040-1713111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/02/2020] [Indexed: 10/23/2022] Open
Abstract
Cardiovascular involvement is uncommon in pediatric patients with hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). In this case report we presented a case of 17-month-old toddler who had a sporadic type of STEC-HUS complicated by acute myocarditis. The patient was successfully treated by a single dose of eculizumab after six doses of therapeutic plasma exchange (TPE) were inefficient to prevent the cardiac complication. Hepatotoxicity was observed after a single dose of eculizumab. Hepatic and cholestatic enzyme levels slowly returned to normal within 6 months. To the best of our knowledge, this is the first case of myocarditis/cardiomyopathy treated with eculizumab in STEC-HUS. This case illustrates the need for vigilance regarding myocardial involvement and eculizumab-induced hepatotoxicity in STEC-HUS.
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Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Nurver Akinci
- Department of Pediatric Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Sirin Sonmez
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Eser Tekin
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Faraz Talebazadeh
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Uzeyir Jafarov
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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Kelham MD, Gleeson L, Alcalde I, Spiritoso R, Proudfoot AG, Scully M. Extra-corporeal membrane oxygenation and Eculizumab: Atypical treatments for typical haemolytic uraemic syndrome. J Intensive Care Soc 2020; 21:191-193. [DOI: 10.1177/1751143719832184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 19-year-old female with no medical history presented with bloody diarrhoea. Investigations revealed an acute kidney injury, thrombocytopenia and microangiopathic haemolysis. A diagnosis of haemolytic uraemic syndrome secondary to Shiga toxin-producing Escherichia coli 055 was confirmed and supportive therapy commenced in the intensive therapy unit. On day 11 of her admission, she rapidly deteriorated with evidence of refractory cardiogenic shock and neurological involvement, both features associated with a poor prognosis. Cross-specialty collaboration prompted a trial of veno-arterial extra-corporeal membrane oxygenation and Eculizumab, a complement inhibitor normally reserved for atypical haemolytic uraemic syndrome, as a bridge to organ recovery. To our knowledge, herein we present the first adult patient with haemolytic uraemic syndrome induced cardiogenic shock successfully supported to cardiac recovery with extra-corporeal membrane oxygenation. The potential role for Eculizumab in Shiga toxin-producing Escherichia coli/typical haemolytic uraemic syndrome is also discussed.
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Affiliation(s)
- Matthew D Kelham
- Perioperative Medicine Department, St Bartholomew's Hospital, London, UK
| | - Liam Gleeson
- Perioperative Medicine Department, St Bartholomew's Hospital, London, UK
| | - Inma Alcalde
- Perioperative Medicine Department, St Bartholomew's Hospital, London, UK
| | - Rosalba Spiritoso
- Perioperative Medicine Department, St Bartholomew's Hospital, London, UK
| | | | - Marie Scully
- Haematology Department, University College London Hospital, London, UK
- Cardiometabolic Programme – NIHR University College London Hospital BRC, London, UK
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Yesilbas O, Yozgat CY, Akinci N, Talebazadeh F, Jafarov U, Guney AZ, Temur HO, Yozgat Y. Sudden Cardiac Arrest and Malignant Ventricular Tachycardia in an 8-Year-Old Pediatric Patient Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli. J Pediatr Intensive Care 2020; 9:290-294. [PMID: 33133747 DOI: 10.1055/s-0040-1708553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/16/2020] [Indexed: 10/24/2022] Open
Abstract
Gastrointestinal, neurological, pancreatic, hepatic, and cardiac dysfunction are extrarenal manifestations of hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). The most frequent cause of death for STEC-HUS is related to the central nervous system and cardiovascular system. Cardiac-origin deaths are predominantly related to thrombotic microangiopathy-induced ischemia and the immediate development of circulatory collapse. STEC-HUS cardiac related deaths in children are rare with only sporadic cases reported. In our literature search, we did not come across any pediatric case report about STEC-HUS causing sudden cardiac arrest and malignant ventricular tachycardia (VT). Herein, we report the case of an 8-year-old female child with a typical clinical manifestation of STEC-HUS. On the seventh day of pediatric intensive care unit admission, the patient had a sudden cardiac arrest, requiring resuscitation for 10 minutes. The patient had return of spontaneous circulation with severe monomorphic pulsed malignant VT. Intravenous treatment with lidocaine, amiodarone and magnesium sulfate were promptly initiated, and we administered multiple synchronized cardioversions, but VT persisted. Furthermore, we were not able to ameliorate her refractory circulation insufficiency by advanced cardiopulmonary resuscitation. Thus, inevitably, the patient lost her life. This case illustrates the need for aggressive management and the dilemma that pediatric critical care specialists, cardiologists, and nephrologists have to face when dealing with STEC-HUS that is worsened by a sudden cardiac arrest accompanied with VT.
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Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Nurver Akinci
- Department of Pediatric Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Faraz Talebazadeh
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Uzeyir Jafarov
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS). Pediatr Nephrol 2019; 34:2495-2507. [PMID: 30382336 DOI: 10.1007/s00467-018-4105-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
Hemolytic uremic syndrome is commonly caused by Shiga toxin-producing Escherichia coli (STEC). Up to 15% of individuals with STEC-associated hemorrhagic diarrhea develop hemolytic uremic syndrome (STEC HUS). Hemolytic uremic syndrome (HUS) is a disorder comprising of thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. The kidney is the most commonly affected organ and approximately half of the affected patients require dialysis. Other organ systems can also be affected including the central nervous system and the gastrointestinal, cardiac, and musculoskeletal systems. Neurological complications include altered mental status, seizures, stroke, and coma. Gastrointestinal manifestations may present as hemorrhagic colitis, bowel ischemia/necrosis, and perforation. Pancreatitis and pancreatic beta cell dysfunction resulting in both acute and chronic insulin dependant diabetes mellitus can occur. Thrombotic microangiopathy (TMA) in cardiac microvasculature and troponin elevation has been reported, and musculoskeletal involvement manifesting as rhabdomyolysis has also been described. Extrarenal complications occur not only in the acute setting but may also be seen well after recovery from the acute phase of HUS. This review will focus on the extrarenal complications of STEC HUS. To date, management remains mainly supportive, and while there is no specific therapy for STEC HUS, supportive therapy has significantly reduced the mortality rate.
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