Gastrointestinal Complications of Post-Diarrheal Hemolytic Uremic Syndrome

Roessingh, Anthony de Buys; Lagausie, Pascal de; Baudoin, V.; Loirat, C; Aigrain, Yves

doi:10.1055/s-2007-965013

Cited by 37 publications

(21 citation statements)

References 20 publications

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“…HC is a relatively uncommon manifestation, as it was observed in 58 of 987 patients (5.87%), and it is clearly different from prodromal bloody diarrhea. Toxic megacolon, perforation, and necrosis of the bowel wall can occur [2,10], and in these cases, early surgical exploration might be indicated [4,5,[11][12][13][14][15].…”

Section: Resultsmentioning

confidence: 99%

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

et al. 2011

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Hemorrhagic colitis (HC) is a severe manifestation of the hemolytic uremic syndrome (HUS). We performed a retrospective analysis of patients with HC with the following aims: (1) to characterize the clinicopathologic features; (2) to evaluate mortality rate; (3) to analyze severity of renal and central nervous system (CNS) disease. Patients with HC assisted between 1981-2009 were evaluated and compared with a control group of 137 patients without HC. Among 987 patients with diarrheal prodrome (D) + HUS, 54 (5.5%) presented HC. Clinical findings included abdominal pain (96%), distension (93%), hematochezia (44%), and abdominal mass (11%). Surgery was indicated in 35 patients (65%), and 17 (48.5%) required bowel resection. Transverse and ascending colon were most frequently affected. Macroscopic evaluation showed bowel necrosis (18) and perforation (12). Histologic evaluation (29) showed that 25 (86.2%) had necrosis of the affected segment (transmural in 21). A leukocyte count >20,000/mm(3) and hematocrit >30% were more common in HC patients than in controls (p < 0.001 and p < 0.0001, respectively). Mortality rate was higher in HC patients (33.3%) than in controls (1.4%; p < 0.0001). Dialysis >10 days, seizures, and coma were more frequent in HC patients than in controls (p < 0.0001). In summary, most patients had prominent abdominal findings, and almost 2/3 patients required surgery. Transverse/ascending colon was most affected, and the main histologic finding was transmural necrosis. Higher hematocrit and leukocytosis were frequent. Mortality rate was extremely high, and most had long-lasting anuria and severe neurologic involvement.

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Section: Resultsmentioning

confidence: 99%

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

et al. 2011

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“…Severe hypertension may lead to central nervous system findings. Gastrointestinal involvement is common; hemorrahgic colitis, ileum/colon perforation, rectal prolapsus, cholestasis, pancreatitis, transient diabetes and peritonitis may occur (25). Increased troponin I level may be observed in relation with myocardial ischemia (26).…”

Section: Clinical and Laboratory Findingsmentioning

confidence: 99%

Hemolytic uremic syndrome

Canpolat

2015

Turk Pediatri Ars

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Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by the triad of thrombotic microangiopathy, thrombocytopenia, and acute kidney injury. Hemolytic uremic syndrome represents a heterogeneous group of disorders with variable etiologies that result in differences in presentation, management and outcome. In recent years, better understanding of the HUS, especially those due to genetic mutations in the alternative complement pathway have provided an update on the terminology, classification, and treatment of the disease. This review will provide the updated classification of the disease and the current diagnostic and therapeutic approaches on the complement-mediated HUS in addition to STEC-HUS which is the most common cause of the HUS in childhood. (Turk Pediatri Ars 2015; 50: 73-82 )

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“…Severe manifestations are hemorrhagic colitis, bowel necrosis, perforation, rectal prolapse, peritonitis, and intussusception [14,15].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Hemolytic Uremic Syndrome Caused by Shiga Toxin-Producing Escherichia coli Infections: An Overview

Abdullah¹,

Al-Sultan

Jassim³

et al. 2014

Clon Transgen

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The purpose of this manuscript is to provide a current overview on the Shiga Toxin / verotoxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) with emphasis on the epidemiology, clinical and laboratory manifestations, pathogenesis, recommended assessment, treatment strategies and prognosis. Hemolytic uremic syndrome (HUS) is a cause of the community-acquired acute renal insufficiency in young children. The outbreak in Germany illustrated both the emerging importance of non-O157 serotypes as agents of human disease and the potential for large-scale methods of food production and distribution to result in widespread disease. Children with STEC-induced HUS typically have a prodromal illness that can rapidly develop severe and multisystem life-threatening complications. STEC infection is acquired through contaminated food or water. Thrombotic microangiopathy is the mechanism of the development of the characteristic pathologic lesion of HUS. Any patient with a recent history of diarrhea and signs of a multi-organ disorder requires a proper assessment for the possible development of HUS. Appropriate laboratory testing for both O157 and non-O157 serotypes, as well as prompt initiation of infection control procedures for confirmed or suspected cases, will facilitate follow-up investigation to identify the source of disease and will help to prevent secondary transmission. Currently, diagnostic test to predict which patients will develop HUS is not available. Supportive care and intravenous fluid replacement are the cornerstones of treatment because of the current lack of safe and specific therapeutic intervention. Culizumab and/or plasma treatment may be considered in patients with severe CNS involvement who have a poor prognosis. None of the multiple therapeutic agents including antithrombotic agents, plasma exchange and/or plasma infusion, tissue-type plasminogen activator, and oral Shiga toxin-binding agent that have been used is recommended. For most patients with uncomplicated STEC-associated gastroenteritis who are treated with supportive care, the prognosis was excellent. Public health interventions are the key to prevent STEC-associated diarrhea and HUS. Researches will improve the care of patients with different HUS types in the years to come. The identification of genetic factors associated with HUS will contribute to a better insight of the pathogenesis of HUS and will have potential therapeutic and preventive implications.

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Gastrointestinal Complications of Post-Diarrheal Hemolytic Uremic Syndrome

Cited by 37 publications

References 20 publications

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

Hemolytic uremic syndrome

Hemolytic Uremic Syndrome Caused by Shiga Toxin-Producing Escherichia coli Infections: An Overview

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