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Hemolytic-uremic syndrome - case report

Elena Ivanova, Zhenya Marinova, Roksana Tsvetanova, Dimitrichka Bliznakova, Mergyul Halilova

Abstract

Introduction: Hemolytic-uremic syndrome (HUS) is a common cause of community-acquired acute kidney injury in young children. It is characterized by the triad of microangiopathic hemolytic ane­mia, thrombocytopenia, and renal insufficiency. The syndrome predominantly occurs in infants and children after prodromal diarrhea. HUS is classified into two main categories, depending on whether it is associated with Shiga-like toxin (Stx) or not and has clinical features in common with thrombot­ic thrombocytopenic purpura (TTP), rendering the differential diagnosis difficult.

Materials and Methods: A case report of a 2-year-old child is discussed. Two days prior to hospital­ization the patient had diarrhea, vomiting and a sudden onset of weakness and lethargy. The physical examination revealed generalized edema, lack of rashes and no neurological deficit.

Results: The laboratory tests showed normocytic normochromic anemia (hemoglobin 59 g/l), throm­bocytopenia (27Ñ…10^9), elevations in serum blood, urea, nitrogen and creatinine. The results from the peripheral blood smear came back with anisocytosis, poikilocytosis and schistocytosis. Urinal­ysis showed proteinuria, leukocyturia and hematuria. Abdominal ultrasonography detected bilater­al hyperechoic renal parenchyma, as well as the presence of free fluid in the pelvis,. Immediate an­tibiotic treatment, infusion therapy and hemotransfusion were initiated. An infusion of furosemide was administered.

Conclusion: With early recognition and intensive supportive care, the mortality for diarrhea-asso­ciated HUS is <5%. Although most of the patients recover renal function completely, there are risks of chronification of the disease. HUS is the most common cause of acute kidney injury in children. Knowing clinical symptomatology and course of action allows for a timely diagnosis and accurate treatment.


Keywords

Hemolytic-uremic syndrome; microangiopathic hemolytic anemia; thrombocytopenia; schistocytosis; generalized edema; acute kidney injury




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4723

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