Renal Microangiopathy of the Hemolytic-Uremic Syndrome in Childhood

Riella, Miguel C.; George, C. R. P.; Hickman, Robert O.; Striker, Gary E.; Slichter, Sherrill J.; Harker, Laurence A.; Quadracci, Leonard J.

doi:10.1159/000180723

Cited by 22 publications

(10 citation statements)

References 18 publications

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“…1,2 The development of microvascular thrombi, composed largely of fibrin, and endothelial-cell swelling are common in this disorder. [3][4][5][6][7] E. coli O157:H7 produces Shiga toxins, which have diverse effects on eukaryot-T ic cells. 8 Presumably, these toxins injure host endothelial cells during the early stages of E. coli O157:H7 infection and initiate a cascade that leads to the hemolytic-uremic syndrome.…”

mentioning

confidence: 99%

Prothrombotic Coagulation Abnormalities Preceding the Hemolytic–Uremic Syndrome

Chandler,

Jelacic,

Boster

et al. 2002

N Engl J Med

201

156

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mentioning

confidence: 99%

Prothrombotic Coagulation Abnormalities Preceding the Hemolytic–Uremic Syndrome

Chandler,

Jelacic,

Boster

et al. 2002

N Engl J Med

201

156

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“…Histopathological examination of the kidneys of children with HUS demonstrates endothelial cell swelling and fibrin deposition in the microvasculature [17,18,19,20], suggesting that host prothrombotic factors may be involved. However, several common prothrombotic factors, such as factor V Leiden, plasminogen activator inhibitor type 1 promoter, factor II (G20210A), and the methylene tetrahydrofolate reductase gene do not appear to play major roles in the evolution of HUS [21].…”

Section: Discussionmentioning

confidence: 99%

Platelet-activating factor and Escherichia coli O157:H7 infections

Smith

Jones

Ciol

et al. 2002

Pediatric Nephrology

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The role of platelet-activating factor (PAF), a phospholipid inflammatory mediator, in Escherichia coli O157:H7-associated hemolytic uremic syndrome (HUS) is unknown. PAF is synthesized by diverse cells and is degraded by PAF-acetylhydrolase (PAF-AH). Deficient PAF-AH activity results from a G-->T transversion at position 994 of exon 9. We examined children infected with E. coliO157:H7 to determine if PAF levels or the PAF-AH ( G994T) mutation reflects the risk of developing HUS. Plasma PAF concentrations were determined using chloroform/methanol extraction, thin layer chromatography purification, and scintillation proximity assay in 10 patients with uncomplicated infection (UI), 10 infected patients who subsequently developed HUS (pre-HUS), 5 HUS patients, and 8 healthy controls. The PAF-AH ( G994T) allele frequency was determined in 52 UI children, 15 with HUS, and 11 controls. Wilcoxon rank sum tests were performed to test differences in location (median) of pairs of groups. PAF levels were higher in the UI ( P=0.04) and pre-HUS ( P=0.01) groups than in healthy controls. No subject had the PAF-AH ( G994T) allele. Thus, elevated plasma PAF levels occur in E. coliO157:H7-infected children, even without HUS, but diminish when HUS develops. The PAF-AH ( G994T) allele does not contribute to the risk of developing HUS.

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“…But, judging also from some recent reports (5,15,21,27), complement activation occurs in only some of the cases. Immunofluorescence studies of renal biopsy specimens have often failed to demonstrate immunoglobulins or complement in the glomerular capillaries (8,12,26). The evidence for immunological mechanisms in HUS is thus weak.…”

Section: Discussionmentioning

confidence: 99%

HEMOLYTIC UREMIC SYNDROME Results of Treatment with Hemodialysis

Ekberg¹,

Holmberg²,

Denneberg³

1977

Acta Paediatrica

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The characteristics of the hemolytic-uremic syndrome in 7 children living in a well defined area in the south of Sweden are described. All the patients had a severe form of the disease and were critically ill. The clinical activity could best be followed by measuring blood platelets and urinary FDP. Early institution of hemodialysis treatment, given almost daily until normalisation of platelet count and urinary output, is the most important live-saving measure. Full dosage heparin seems not to be necessary. Six patients survived and were followed-up for 1-7 years. When last seen they all had normal renal function and blood pressure.

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Renal Microangiopathy of the Hemolytic-Uremic Syndrome in Childhood

Cited by 22 publications

References 18 publications

Prothrombotic Coagulation Abnormalities Preceding the Hemolytic–Uremic Syndrome

Prothrombotic Coagulation Abnormalities Preceding the Hemolytic–Uremic Syndrome

Platelet-activating factor and Escherichia coli O157:H7 infections

HEMOLYTIC UREMIC SYNDROME Results of Treatment with Hemodialysis

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