DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ

Zeynep Yürük Yıldırım; Alev Yılmaz; Bağdagül Yavaş Aksu; Güntülü Şık; İlmay Bilge; Agop Çıtak; Sevinç Emre

doi:10.18017/iuitfd.m.13056441.2015.78/2.46-50

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Year 2015, Volume: 78 Issue: 2, 46 - 50, 14.08.2015

Zeynep Yürük Yıldırım , Alev Yılmaz Bağdagül Yavaş Aksu , Güntülü Şık İlmay Bilge Agop Çıtak , Sevinç Emre

https://doi.org/10.18017/iuitfd.m.13056441.2015.78/2.46-50

Abstract

Objective: Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The most common form of HUS in children is Shigatoxin-producing Escherichia coli (STEC) related HUS. HUS is the most common causeof acute renal failure in Europe whereas it was not observed in the same frequency in our country. However, in 2011, after the outbreak of Escherichia coli (E. Coli) gastroenteritis and HUS in Germany, we observed significantly increased cases of HUS in our country. In this retrospective study, we aimed to determine the clinical features and prognosis of HUS patients who admitted with a history of diarrhea during this breakout. MaterialsandMethods: We followed up 9 patients with diarrhea associated HUS in 2011. Blood cell count, peripheral blood smear, serum urea, creatinine, electrolytes, complement C3, direct Coombs test, cultures of urine as well as blood and stool, chest X-ray were performed. Results: The mean age was 5.8 ± 4.2 years (3 months-12 years). Six of the patients had complete anuria, the first urine appeared 2-7 days after the presentation. Mean duration of hospitalization was 17.66±13.77 days . In healing process, first platelet count increased. Urine out put appeared soon after the platelet count rose in the anuric patients, mean duration of anuria and oliguria were 7±3 days and 4±5 days , respectively. Conclusion: The results of our study indicate that it may be appropriate to accept as atypical HUS and treat the patients with low C3 levels, vital organ involvement, long-term renal failure and negative stool tests for verotoxin though it cannot be confirmed at the time of admission

Keywords

Hemolytic uremic syndrome; HUS; child

References

Elliott EJ, Robins-Browne RM, O'Loughlin EV et al. the Contributors Surveillance Unit. Nationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological 2001;85(2):125-31. Australian Paediatric ArchDis Child.
Lynn RM, O'Brien SJ, Taylor CM et al. Childhood hemolytic uremic syndrome, United Kingdom and Ireland. Emerg Infect Dis. 2005;11(4):590-6.
Frank C, Werber D, CramerJP, et al. HUS Investigation Team. Epidemic profile of Shiga- toxin-producing Escherichia coliO104:H4 outbreak in Germany. N Engl J Med 2011;365:1771-80.
Gault G, WeillFX, Mariani-Kurkdjian P, et al. Outbreak of haemolytic uraemic syndrome and bloody diarrhea due to Escherichia coli O104:H4, south-west France. Euro Surveill 2011;16. doi:pii: 19905.
Ekinci Z, Candan C, Alpay H et al. Hemolytic uremic syndrome outbreak in Turkey in 2011. Turk J Pediatr. 2013;55(3):246-52.
Johnson S and Taylor CM: Hemolytic uremic syndrome. In: AvnerED, Harmon WEB, Niaudet P, Yoshikawa N (eds): Pediatric Nephrology, Berlin, Hidelberg, Springer-Verlag, 6th ed. 2009;1155-80.
Oakes RS, Kirkham JK, Nelson RD, Siegler RL. Duration of oliguria and anuria as predictors of chro nic renal-related sequelae in post- diarrheal hemolytic uremic Nephrol. 2008;23(8):1303-8. syndrome. Pediatr
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114 (2 Supp l4th Report):555-76.
Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of shigatoxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study. J Infect Dis.2002;15;186(4):493-500.
.Micheletti MV, Lavoratti G, Materassi M, Pela I. Hemolytic uremics yndrome: epidemiological and clinical features of a pediatric population in Tuscany. Kidney Blood PressRes.2010;33(5):399- 404.
Loos S, Ahlenstiel T, Kranz B et al. An Outbreak of ShigaToxin–Producing Escherichia coli O104:H4 Hemolytic Presentation and Short term Outcome in Children. Clin Infect Dis. 2012;55(6):753-9.
Uchida H, Kiyokawa N, Taguchi T, Horie H, Fujimoto J, Takeda T. Shigatoxins induce apoptosis in pulmonary epithelium-derived cells. J Infect Dis. 1999 Dec;180(6):1902-11.
Ariceta G, Besbas N, Johnson S et al. European
Paediatric Study Group for HUS. Guideline for
the investigation and initial therapy of diarrhea
negative hemolytic uremic syndrome.
Nephrol. 2009;24(4):687-96. Pediatr

DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ

Year 2015, Volume: 78 Issue: 2, 46 - 50, 14.08.2015

Zeynep Yürük Yıldırım , Alev Yılmaz Bağdagül Yavaş Aksu , Güntülü Şık İlmay Bilge Agop Çıtak , Sevinç Emre

https://doi.org/10.18017/iuitfd.m.13056441.2015.78/2.46-50

Abstract

Amaç: Hemolitik Üremik Sendrom (HÜS) mikroanjiopatik hemolitik anemi, trombositopeni ve akut böbrek yetersizliği ile tanımlanan bir tablodur. Çocuklarda HÜS etiyolojisinde Shiga toksin üreten Escherichiacoli’nin (STEC) neden olduğu HÜS en sık görülen formudur.Avrupa ülkelerinde akut böbrek yetersizliği etiyolojisinde en sık neden olarak belirtilen HÜS ülkemizde aynı sıklıkla görülmemektedir. Ancak 2011 yılında Almanya’da yaşanan Escherichiacoli (E.coli)gastroenteriti ve HÜS salgını sonrasında aynı yıl ülkemizde diyare sonrası gelişen HÜS vakalarında artış saptadık. Bu retrospektif çalışmada amacımız bu salgın sırasında diyare öyküsü ile başvuran HÜS tanılı hastalarımızın klinik özellikleri ve prognozunun belirlenmesidir.Gereç ve Yöntem: İkibinonbir yılında 9 HÜS hastası izlendi. Tam kan sayımı, periferik kan yayması, kan üre, kreatinin, elektrolitler, kompleman C3, direkt coombs testi, idrar, kan ve dışkı kültürleri ve akciğer grafisi yapıldı. Bulgular: Ortalama yaş 5,8±4,2 (3ay-12 yaş) yaştı. Altı hastada anüri mevcuttu ve ilk idrar çıkışı başvurudan 2-7 gün sonra görüldü. Ortalama hastanede yatış süresi 17,66±13,77 (8-52) gündü. İyileşme sürecinde ilk olarak trombosit sayısı yükseldi. Anürik hastalarda idrar çıkışı trombosit sayısının yükselmeye başlamasından hemen sonra görüldü. Ortalama oligüri ve anüri süresi sırasıyla 7±3 (3-10) ve 4±5 (1-14) gündü.Sonuç: Çalışmamızın sonuçları, serum C3 düzeyi düşük olan, hayati organ tutulumu gösteren, böbrek yetersizliği uzun süren ve dışkıda verotoksin negatif olan hastaların atipikHÜS nedenleri açısından tetkikleri tamamlanmamış olsa bile atipikHÜS gibi kabul edilerek tedavi edilmesinin uygun olacağını düşündürmektedir.

Keywords

Hemolitik üremik sendrom, HÜS, anemi, çocuk

References

Elliott EJ, Robins-Browne RM, O'Loughlin EV et al. the Contributors Surveillance Unit. Nationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological 2001;85(2):125-31. Australian Paediatric ArchDis Child.
Lynn RM, O'Brien SJ, Taylor CM et al. Childhood hemolytic uremic syndrome, United Kingdom and Ireland. Emerg Infect Dis. 2005;11(4):590-6.
Frank C, Werber D, CramerJP, et al. HUS Investigation Team. Epidemic profile of Shiga- toxin-producing Escherichia coliO104:H4 outbreak in Germany. N Engl J Med 2011;365:1771-80.
Gault G, WeillFX, Mariani-Kurkdjian P, et al. Outbreak of haemolytic uraemic syndrome and bloody diarrhea due to Escherichia coli O104:H4, south-west France. Euro Surveill 2011;16. doi:pii: 19905.
Ekinci Z, Candan C, Alpay H et al. Hemolytic uremic syndrome outbreak in Turkey in 2011. Turk J Pediatr. 2013;55(3):246-52.
Johnson S and Taylor CM: Hemolytic uremic syndrome. In: AvnerED, Harmon WEB, Niaudet P, Yoshikawa N (eds): Pediatric Nephrology, Berlin, Hidelberg, Springer-Verlag, 6th ed. 2009;1155-80.
Oakes RS, Kirkham JK, Nelson RD, Siegler RL. Duration of oliguria and anuria as predictors of chro nic renal-related sequelae in post- diarrheal hemolytic uremic Nephrol. 2008;23(8):1303-8. syndrome. Pediatr
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114 (2 Supp l4th Report):555-76.
Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of shigatoxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study. J Infect Dis.2002;15;186(4):493-500.
.Micheletti MV, Lavoratti G, Materassi M, Pela I. Hemolytic uremics yndrome: epidemiological and clinical features of a pediatric population in Tuscany. Kidney Blood PressRes.2010;33(5):399- 404.
Loos S, Ahlenstiel T, Kranz B et al. An Outbreak of ShigaToxin–Producing Escherichia coli O104:H4 Hemolytic Presentation and Short term Outcome in Children. Clin Infect Dis. 2012;55(6):753-9.
Uchida H, Kiyokawa N, Taguchi T, Horie H, Fujimoto J, Takeda T. Shigatoxins induce apoptosis in pulmonary epithelium-derived cells. J Infect Dis. 1999 Dec;180(6):1902-11.
Ariceta G, Besbas N, Johnson S et al. European
Paediatric Study Group for HUS. Guideline for
the investigation and initial therapy of diarrhea
negative hemolytic uremic syndrome.
Nephrol. 2009;24(4):687-96. Pediatr

There are 17 citations in total.

Details

Primary Language	Turkish
Journal Section	Clinical Research
Authors	Zeynep Yürük Yıldırım Alev Yılmaz This is me Bağdagül Yavaş Aksu Güntülü Şık This is me İlmay Bilge This is me Agop Çıtak Sevinç Emre This is me
Publication Date	August 14, 2015
Submission Date	December 11, 2014
Published in Issue	Year 2015 Volume: 78 Issue: 2

Cite

APA	Yürük Yıldırım, Z., Yılmaz, A., Yavaş Aksu, B., Şık, G., et al. (2015). DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ. Journal of Istanbul Faculty of Medicine, 78(2), 46-50. https://doi.org/10.18017/iuitfd.m.13056441.2015.78/2.46-50
AMA	Yürük Yıldırım Z, Yılmaz A, Yavaş Aksu B, Şık G, Bilge İ, Çıtak A, Emre S. DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ. İst Tıp Fak Derg. August 2015;78(2):46-50. doi:10.18017/iuitfd.m.13056441.2015.78/2.46-50
Chicago	Yürük Yıldırım, Zeynep, Alev Yılmaz, Bağdagül Yavaş Aksu, Güntülü Şık, İlmay Bilge, Agop Çıtak, and Sevinç Emre. “DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ”. Journal of Istanbul Faculty of Medicine 78, no. 2 (August 2015): 46-50. https://doi.org/10.18017/iuitfd.m.13056441.2015.78/2.46-50.
EndNote	Yürük Yıldırım Z, Yılmaz A, Yavaş Aksu B, Şık G, Bilge İ, Çıtak A, Emre S (August 1, 2015) DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ. Journal of Istanbul Faculty of Medicine 78 2 46–50.
IEEE	Z. Yürük Yıldırım, A. Yılmaz, B. Yavaş Aksu, G. Şık, İ. Bilge, A. Çıtak, and S. Emre, “DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ”, İst Tıp Fak Derg, vol. 78, no. 2, pp. 46–50, 2015, doi: 10.18017/iuitfd.m.13056441.2015.78/2.46-50.
ISNAD	Yürük Yıldırım, Zeynep et al. “DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ”. Journal of Istanbul Faculty of Medicine 78/2 (August 2015), 46-50. https://doi.org/10.18017/iuitfd.m.13056441.2015.78/2.46-50.
JAMA	Yürük Yıldırım Z, Yılmaz A, Yavaş Aksu B, Şık G, Bilge İ, Çıtak A, Emre S. DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ. İst Tıp Fak Derg. 2015;78:46–50.
MLA	Yürük Yıldırım, Zeynep et al. “DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ”. Journal of Istanbul Faculty of Medicine, vol. 78, no. 2, 2015, pp. 46-50, doi:10.18017/iuitfd.m.13056441.2015.78/2.46-50.
Vancouver	Yürük Yıldırım Z, Yılmaz A, Yavaş Aksu B, Şık G, Bilge İ, Çıtak A, Emre S. DİYARE ÖYKÜSÜ OLAN HEMOLİTİK ÜREMİK SENDROM TANILI HASTALARIN KLİNİK ÖZELLİKLERİ. İst Tıp Fak Derg. 2015;78(2):46-50.