Abstract
Introduction:
Atypical hemolytic uremic syndrome (aHUS) is a rare disorder characterized by
the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute
kidney injury, which primarily affects preschool-aged children. This study’s
aim was to describe the clinical profile, management, and long-term outcome
of the genetic aHUS patients admitted to a tertiary care pediatric
nephrology center during 20 years.
Methods:
We performed a retrospective analysis of the clinical records of all aHUS
patients younger than 18 years with identified genetic mutations. Data on
clinical features, genetic study, therapeutic interventions, and long-term
outcomes were reviewed.
Results:
Five cases of aHUS with an identified genetic mutation were included; all
were inaugural cases with the youngest being 4 months old. Complement factor
H gene mutation was identified in four patients. Therapeutic plasma exchange
was performed for acute management in 4 patients, one of whom also needed
acute renal replacement therapy (peritoneal dialysis). All patients went on
complete remission, 2 had more than one relapse but only 1 of these
progressed to chronic kidney disease during the follow-up period (median
(25th-75th percentile), 136 (43.5-200.5) months).
Conclusion:
In children, the prognosis of renal function seems to be strongly dependent
on the genetic background, thus being crucial to perform genetic study in
all aHUS cases. In our cohort, 2 patients presented genetic mutations not
previously described. Recent innovations on the genetic field leading to the
identification of new mutations has lead to a better understanding of aHUS
pathogenesis, but further studies, focusing on the genotype-phenotype
correlation, with longer follow-up periods, are needed.
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