Haemolytic-uraemic syndrome: an analysis of prognostic features.

Abstract

SUMMARY Seventy-two children with the haemolytic-uraemic syndrome were seen between 1969 and 1980 at The Hospital for Sick Children and Guy's Hospital, London. They probably constitute the majority of such cases in south-east England during that period. Boys and girls were affected equally, the mean age at presentation was 3* 5 years, and a peak incidence of the disorder in summer months was observed. In 52 (72 %) there was a history of diarrhoea at onset. Fifty-seven (78 %) were managed by dialysis. Fifty (70 %) of the 72 children had a favourable outcome with complete recovery, 3 (4 %) died in the acute phase of the illness, 8 (11 %) had residual hypertension or chronic renal failure, and 11 (16 %) never recovered renal function. The probability of complete recovery of renal function was analysed by logistic regression which indicated that younger age, presentation in the summer months, diarrhoea at onset and, in those patients who were dialysed, a short prodromal illness were associated with a good outcome. Further analysis of the interaction among these variables in the patient group as a whole indicated that diarrhoea favoured a good outcome among boys but not girls.In 1955 Gasser et al. described the association of an acute haemolytic anaemia, thrombocytopenia, and renal failure.' The disorder is now known as the haemolytic-uraemic syndrome (HUS), and is recognised as a major cause of acute renal failure in children. It is more common under age 4 years, and is often associated with a history of diarrhoea or upper respiratory tract infection.2-7 There appear to be endemic areas-such as Argentina6 and the Netherlands7-and elsewhere the disorder often occurs in mini-epidemics. It is known that although most affected children recover a few do not, and this heterogeneity of outcome is a major complicating factor in the analysis of results of treatment or the design of prospective therapeutic trials.In a previous analysis of 34 cases in England, a poor outcome was associated with persistent anaemia, hepatosplenomegaly, purpura, and the absence of antecedent diarrhoea.8 In order to analyse the natural history and predictive variables of the disorder as seen in children resident in south-east England, we have reviewed the case records of all the 72 such children admitted to the two renal units in London responsible for the care of most children with acute renal failure in the area. 101Patients and methods HUS was diagnosed in children with renal failure, a haemolytic anaemia with fragmented cells and thrombocytopenia in whom other causes, particularly septicaemia, had been excluded. The records of the 72 such children

Outcome of acute renal failure in children in Chennai, India

“…In the present study, the maximum number of cases of ARF was reported between the ages of 1 to 4 years. This is correlated with the studies conducted by Corlos et al and Trornpeter et al 1,2 This is because of the increased incidence of acute glomerulonephritis in this age group. This acute glomerulonephritis is usually secondary to skin infection occurring in these children.…”

“…But in our study a mortality of less than 10% was noted. 2 The patient survival is very poor when the child is less than l year of age. This fact is well appreciated in the present study.…”

“…Intrinsic renal failure results from diseases of kidney while post renal failure is essentially due to obstructive disorders. 2 The precipitating diseases form the major presenting feature. Renal failure itself can manifest with oliguria, pallor, edema, anemia, hypertension, vomiting and lethargy.…”

“…But this background history may point towards Haemolytic Uremic Syndrome (HUS) and renal vein thrombosis (RVT) also. 2 Recent, past history of infection denotes post infective Glomerulonephritis (PIGN). Features of recurrent abdominal pain, arthritis and arthralgia, jaundice, wheeze and skin rashes will suggestive of vasculitis.…”

Public health implications of a case of haemolytic–uraemic syndrome associated with a concomitant outbreak of mild gastroenteritis in a small rural community

“…The haemolytic-uraemic syndrome (HUS) is the most common cause of acute renal failure in children and is also characterized by thrombocytopaenia, and microangiopathic haemolytic anaemia [1]. More than 80 % of HUS cases occur as a complication of intestinal infections with shiga-toxin (ST)-producing Escherichia coli (STEC) [2][3][4].…”