Öz
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
Anahtar Kelimeler
Kaynakça
- 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
Öz
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.
Anahtar Kelimeler
Kaynakça
- 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
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Klinik Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Ağustos 2015 |
| Gönderilme Tarihi | 11 Aralık 2014 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 78 Sayı: 2 |
Kaynak Göster
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61