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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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Typical or Atypical Hemolytic Uremic Syndrome and the Use of Eculizumab: 4 Illustrative Cases. J Pediatr Hematol Oncol 2019; 41:e459-e462. [PMID: 30933023 DOI: 10.1097/mph.0000000000001449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Typical hemolytic uremic syndrome (HUS) in children is caused mostly by Escherichia coli 0157:H7 in our country. Atypical HUS (aHUS) causes include Streptococcus pneumoniae, methyl malonic aciduria, deficiency of ADAMST 13, and genetic or acquired disorder of the complement. Treatment of HUS relies on supportive measures while treatment of aHUS includes plasmapheresis and specific treatments. Recently, eculizumab has been proposed for the treatment of aHUS and many clinicians now believe that eculizumab should be the first-line standard of care. The purpose of this article is to illustrate the difficulties in the diagnostic process of HUS and therefore the subsequent problem to promptly choose the appropriate treatment. To date, workup of HUS continues to take many days leaving the clinicians with a choice between several therapeutic options. With the emergence of eculizumab, it becomes crucial to find faster diagnostic tools and to adapt HUS treatment protocols. We reported here clinical cases where eculizumab use was probably not appropriate once the correct diagnosis of typical HUS was made and cases where it would have been useful because of the late diagnosis of aHUS.
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Balgradean M, Croitoru A, Leibovitz E. An outbreak of hemolytic uremic syndrome in southern Romania during 2015-2016: Epidemiologic, clinical, laboratory, microbiologic, therapeutic and outcome characteristics. Pediatr Neonatol 2019; 60:87-94. [PMID: 29807724 DOI: 10.1016/j.pedneo.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/16/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND AND AIMS To describe the epidemiologic, clinical, microbiological, therapeutic and outcome characteristics of a HUS outbreak occurring in southern Romania from 2015 to 2016. METHODS We retrospectively collected data from the medical records of all HUS cases hospitalized at the pediatric nephrology department of Marie Curie Children's Hospital of Bucharest, Romania. RESULTS There were 32 HUS cases (19 girls/13 boys, 87.6% <2 years), all associated with diarrhea (bloody in 13, 40.6%). Thirteen (40.6%) and 4 (12.5%) patients had oliguria and anuria at admission. Extreme pallor, generalized edema, vomiting, dehydration, fever and seizures were found in 100%, 56.3%, 31.3%, 31.3%, 25% and 9.4% of patients, respectively. E. coli and STEC were identified in the stools of 6 and 8 patients, respectively; E. coli O26 and O157 infection were documented serologically in 10 and 3 children, respectively. There were 15/32 (46.9%) patients with confirmed HUS. Eighteen (56.3%) patients were hypertensive; other complications included infections, left ventricular hypertrophy, cardiopulmonary arrest, seizures and encephalopathy in 62.5%, 37.5%, 28.3%, 18.8% and 12.5%, respectively. Peritoneal dialysis and hemodialysis were performed in 23 (72%) and 2 patients, respectively. Three patients (9.4%) died early during hospitalization. A 6-12-month follow-up of 26 patients revealed that 65.4% had post-HUS sequelae (persistent hypertension and chronic renal failure in 34.6% and 30.8%, respectively). CONCLUSIONS The principal STEC serotype involved was O26:H11 and the number of confirmed HUS cases reached half of the patients. Compared with the medical literature, this outbreak had a higher rate of complications and renal sequelae and was associated with a high fatality rate.
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Affiliation(s)
- Mihaela Balgradean
- Nephrology & Dialysis Department, Children's Emergency Hospital " M. S. Curie", "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Croitoru
- Nephrology & Dialysis Department, Children's Emergency Hospital " M. S. Curie", "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Noronha N, Costa FD, Dias A, Dinis A. Complement factor B mutation-associated aHUS and myocardial infarction. BMJ Case Rep 2017; 2017:bcr-2017-219716. [PMID: 28710236 DOI: 10.1136/bcr-2017-219716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 6-month-old female infant was referred with a 3-day history of low-grade fever, slight nasal congestion and rhinorrhoea. On admission, the clinical findings were unremarkable and she was discharged home. However, she became progressively more listless with a decreased urine output and was once again seen in the emergency department. Analytically she was found to have metabolic acidosis, hyperkalaemia, thrombocytopaenia, anaemia and schistocytes in the peripheral blood smear. Based on these findings, the diagnosis of haemolyticâ-uremic syndrome was made. A few hours postadmission, there was an abrupt clinical deterioration. She went into cardiorespiratory arrest and she was successfully resuscitated. An ST-segment elevation was noted on the ECG monitor and the troponin I levels were raised, suggesting myocardial infarction. Despite intensive supportive therapy, she went into refractory shock and died within 30 hours.
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Affiliation(s)
- Natália Noronha
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Filipa Dias Costa
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Andrea Dias
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Alexandra Dinis
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
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Rigamonti D, Simonetti GD. Direct cardiac involvement in childhood hemolytic-uremic syndrome: case report and review of the literature. Eur J Pediatr 2016; 175:1927-1931. [PMID: 27659663 DOI: 10.1007/s00431-016-2790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. Here, we report the case of a 4.5-year-old boy with hemolytic-uremic syndrome and sudden onset, 6 h later, of hemodynamic compromise secondary to a cardiac thrombotic micro-angiopathy. The child died. In the literature, we found 18 further cases with cardiac compromise ≤25 days after diagnosis. The following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis. CONCLUSION We were able to document only 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise. Nonetheless, we speculate that a direct cardiac compromise accounts for many cases of childhood hemolytic-uremic syndrome complicated by sudden death during the initial hospitalization. Hence, we propose to always measure troponin in children with hemolytic-uremic syndrome to detect a latent myocardial damage. What is Known: • Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. What is New: • This study documents 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise ≤ 25 days after diagnosis. • The Following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis.
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Affiliation(s)
- Davide Rigamonti
- Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland. .,Division of Pediatric Nephrology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland.
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Biomarkers detect involvement of acute myocardial injury in a paediatric haemolytic-uraemic syndrome patient. Cardiol Young 2016; 26:983-6. [PMID: 26838960 DOI: 10.1017/s1047951115002759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although extrarenal manifestations of haemolytic-uraemic syndrome are not frequent, myocardial dysfunction should be given special consideration because of the importance of proper early haemodynamic management and potential complications. We report the case of a 21-month-old child with haemolytic-uraemic syndrome who developed clinical signs of poor myocardial function with depressed myocardial function noted by bedside echocardiography and significant elevation of biomarkers. Early intervention and supportive treatment for the patient were crucial during the acute phase of cardiac failure, and repeated monitoring of biomarkers and ecocardiography were useful diagnostic tools that provided relevant information throughout the patient's evolution.
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Yanagisawa R, Ishii E, Motoki N, Yamazaki S, Morita D, Sakashita K, Shiohara M, Tanaka M, Hidaka Y, Kubota N, Hidaka E, Ogiso Y, Nakamura T, Yasukochi S. Pretransplant-corrected QT dispersion as a predictor of pericardial effusion after pediatric hematopoietic stem cell transplantation. Transpl Int 2015; 28:565-74. [DOI: 10.1111/tri.12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/09/2014] [Accepted: 01/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ryu Yanagisawa
- Division of Hematology/Oncology; Nagano Children's Hospital; Azumino Japan
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Eizaburo Ishii
- Department of Pediatrics; Nagano Prefectural Suzaka Hospital; Suzaka Japan
| | - Noriko Motoki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Shoko Yamazaki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Daisuke Morita
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Kazuo Sakashita
- Division of Hematology/Oncology; Nagano Children's Hospital; Azumino Japan
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Masaaki Shiohara
- Department of Pediatrics; School of Dentistry; Matsumoto Dental University; Shiojiri Japan
| | - Miyuki Tanaka
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Yoshihiko Hidaka
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Noriko Kubota
- Department of Laboratory Medicine; Nagano Children's Hospital; Azumino Japan
- Life Science Research Center; Nagano Children's Hospital; Azumino Japan
| | - Eiko Hidaka
- Department of Laboratory Medicine; Nagano Children's Hospital; Azumino Japan
- Life Science Research Center; Nagano Children's Hospital; Azumino Japan
| | - Yoshifumi Ogiso
- Division of Clinical Pathology; Nagano Children's Hospital; Azumino Japan
| | - Tomohiko Nakamura
- Division of Hematology/Oncology; Nagano Children's Hospital; Azumino Japan
- Life Science Research Center; Nagano Children's Hospital; Azumino Japan
| | - Satoshi Yasukochi
- Division of Pediatric Cardiology; Nagano Children's Hospital; Azumino Japan
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Petrie CJ, Weir RAP, Lindsay MM, Padmanabhan N, Douglas K. Severe left ventricular systolic dysfunction in a patient with a typical haemolytic-uraemic syndrome treated with rituximab--coincidence or cause? Clin Kidney J 2010; 3:269-270. [PMID: 28657056 PMCID: PMC5477969 DOI: 10.1093/ndtplus/sfq055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 03/22/2010] [Indexed: 11/13/2022] Open
Affiliation(s)
- Colin J. Petrie
- Department of Cardiology, Western Infirmary, Glasgow G11 6NT, Scotland, UK
| | - Robin A. P. Weir
- Department of Cardiology, Western Infirmary, Glasgow G11 6NT, Scotland, UK
| | | | - Neal Padmanabhan
- Department of Nephrology, Western Infirmary, Glasgow G11 6NT, Scotland, UK
| | - Kenny Douglas
- Department of Haematology, Gartnavel General Hospital, Glasgow G12 0YN, Scotland, UK
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Sallée M, Daniel L, Piercecchi MD, Jaubert D, Fremeaux-Bacchi V, Berland Y, Burtey S. Myocardial infarction is a complication of factor H-associated atypical HUS. Nephrol Dial Transplant 2010; 25:2028-32. [PMID: 20305136 DOI: 10.1093/ndt/gfq160] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiac complications are frequently seen in thrombotic thrombocytopaenic purpura related to ADAMTS13 deficiency. We describe the case of a 43-year-old woman who was diagnosed with an atypical haemolytic-uraemic syndrome (aHUS) associated with a pathogenic mutation in the factor H gene (C623S). After 15 days of treatment, she suffered a sudden cardiac arrest and died despite intensive resuscitation attempts. She showed only one cardiovascular risk factor, hypercholesterolaemia. Her sudden death was secondary to cardiac infarction related to a coronary thrombotic microangiopathy. This is the first case of aHUS related to a mutation in the factor H gene associated with cardiac microangiopathy. This case emphasizes the need to screen for cardiac complication during the treatment of aHUS.
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Affiliation(s)
- Marion Sallée
- Centre de néphrologie et transplantation rénale, AP-HM, Hôpital de la Conception, Université de la Méditerranée, Marseille, France
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Mohammed J, Filler G, Price A, Sharma AP. Cardiac tamponade in diarrhoea-positive haemolytic uraemic syndrome. Nephrol Dial Transplant 2008; 24:679-81. [PMID: 19033247 DOI: 10.1093/ndt/gfn649] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The spectrum of extra-renal involvement secondary to diarrhoeal (D+) haemolytic uraemic syndrome (HUS) includes neurological, gastrointestinal, hepatic, pancreatic and cardiac complications. Among the cardiac complications, myocardial injury has been more commonly reported with HUS. Literature is scarce on HUS-associated pericardial involvement. We report a HUS-induced significant pericardial effusion that resulted in a cardiac tamponade. We also discuss the diagnostic and therapeutic implications of this complication.
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Affiliation(s)
- Javed Mohammed
- Department of Paediatrics, Children's Hospital at London Health Science Centre, University of Western Ontario, London, Ontario, Canada
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