Atypical hemolytic uremic syndrome in human immunodeficiency virus-1-infected children

Abstract

We describe the clinical and pathological findings of the hemolytic uremic syndrome (HUS) in two children with human immunodeficiency virus (HIV) infection. Both patients presented with microangiopathic hemolytic anemia, thrombocytopenia, and subsequently developed renal failure. The diagnosis of HUS was confirmed by renal histopathology in both patients. None of these children presented with bloody diarrhea, evidence of circulating antibody response to Escherichia coli O157 lipopolysaccharide, or other known risk factors for HUS, except for the presence of HIV infection. Each patient was treated with intravenous plasma infusion and renal replacement therapy. Their clinical course was characterized by non-oliguria and lack of significant hypertension throughout the acute phase of the disease. Despite these favorable clinical parameters, both patients developed end-stage renal failure. The etiology of this atypical HUS characterized by poor renal survival remains unknown and the role of HIV infection in its pathogenesis, although possible, is unclear.

Hemolytic uremic syndrome

“…Aspergillus fumigates is a rare etiologic agent. Sometimes HUS occurs as a consequence of vaccination with an influenza triple antigen vaccine, typhoid-paratyphoid A and B vaccine, or polio vaccine (1,3,4,8,10,21,22,23,28,34,35).…”

“…The most important diseases are lupus erithematodes, scleroderma and antiphospholipid antibody syndrome. Primary glomerulopathies and allogenic hematopoetic cell transplantation account for about 0.05% of all HUS cases (15,16,35).…”

“…The first diagnostic step in this case is measurement of I S S U E 3 , 2 0 1 5 the homocystine and methylmalonate levels in urine, which are increased. After that genetic analyses may be implemented (7,35). Notice the use of drugs, transplantations or pregnancy as a potential cause for aHUS in adults.…”

“…This drug is effective in D+HUS (used in the German outbreak in 2011) and severe TTP and ADAMTS 13 deficiency as a result of anti-ADAMTS 13 antibodies in patients who stay resistant to plasma therapy. Eculizumab is so effective in relapsing aHUS after renal transplantation (21,22,23,35).…”

Glycosphingolipids in HIV/AIDS: The Potential Therapeutic Application

“…Thus, perturbations in GSL expression, and antibodies produced to GSL in HIV-1 infection may be immunosuppressive. It is of interest to note that HIV infected patients are more prone to haemolytic uremic syndrome (HUS) (Turner et al, 1997). HUS is characterised by thrombotic microangiopathy of the renal glomeruli mediated by verotoxin/Gb 3 binding (Muthing et al, 2009).…”