Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial

Greinacher, Andreas; Friesecke, Sigrun; Abel, Peter; Dressel, Alexander; Stracke, Sylvia; Fiene, Michael; Ernst, Friedlinde; Selleng, Kathleen; Weißenborn, Karin; Schmidt, Bernhard M.W.; Schiffer, Mario; Felix, Stephan B.; Lerch, Markus M.; Kielstein, Jan T.; Mayerle, Julia

doi:10.1016/s0140-6736(11)61253-1

Cited by 130 publications

(66 citation statements)

References 32 publications

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“…However, if the child developed serious neurologic signs and symptoms, we would consider the use of plasma exchange, immunoadsorption treatment, and potentially eculizumab (33,34). Although plasma volume expansion has not been noted to be beneficial in the majority of children with DHUS, a metaanalysis did suggest the possibility of some benefit of plasma exchange in these patients (30).…”

Section: Discussionmentioning

confidence: 99%

Attending Rounds

Clark

Hildebrand

2012

Clinical Journal of the American Society of Nephrology

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SummaryThe classification of thrombotic microangiopathy has evolved and expanded due to treatment and advances in understanding of the diseases associated with this clinical presentation. The three clinical forms of thrombotic microangiopathy-thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and disseminated intravascular coagulation-encompass a wide range of disorders that can be classified as either primary (idiopathic) or secondary to another identifiable disease or clinical context. Identification of an inhibitor to a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) in the idiopathic and acute forms of TTP, recognition of the absence of ADAMTS13 inhibition in diarrheal HUS, identification of complement abnormalities in atypical HUS, and a better understanding of the role of plasma therapy, rituximab, and eculizumab therapy have all had a major effect on current understanding of the thrombotic microangiopathies. In this Attending Rounds, a patient with a thrombotic microangiopathy is presented, along with discussion highlighting the difficulty of differentiating TTP from HUS and disseminated intravascular coagulation, the need for a prompt diagnosis, and the role for plasma therapy in appropriately selected patients. The discussion attempts to provide a simple clinical approach to the diagnosis, treatment options, and future course of adults and children suffering from a thrombotic microangiopathy.

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Section: Discussionmentioning

confidence: 99%

Attending Rounds

Clark

Hildebrand

2012

Clinical Journal of the American Society of Nephrology

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“…Eculizumab, a first-in-class terminal complement inhibitor, specifically targets uncontrolled complement activation, and is also indicated for the treatment of patients with atypical HUS (aHUS) to inhibit complement-mediated thrombotic microangiopathy (TMA), although it is off-label use of this drug (it awaits registration for this indication in Europe, while in September 2011, the FDA granted accelerated approval for use in aHUS). We have to bear in mind that this treatment is associated with enhanced risk of viral infections, and meningococcal vaccination is recommended in patients with complement deficiencies [142,143].…”

Section: Nephrology 2011 Updatementioning

confidence: 99%

Lipids, Blood Pressure, Kidney-what was New in 2012?

Banach¹,

Hering²,

Myśliwiec³

et al. 2012

International J. of Pharmacology

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“…15 Finally, an interesting therapeutic approach is immunoadsorption. 16,17 This method is proved for its effectiveness in the reduction of renal and neurological disorders in patients with HUS and is suggested for patients for whom other therapeutic choices have failed. 16 If good management is provided, follow-up of the patients usually reveals complete recovery.…”

Section: Clinical Aspects Of Renal Failure In the Recent 2011 E Colimentioning

confidence: 99%

“…16 If good management is provided, follow-up of the patients usually reveals complete recovery. [11][12][13][14][15][16][17][18][19] …”

Section: Clinical Aspects Of Renal Failure In the Recent 2011 E Colimentioning

confidence: 99%

“…But in case that infection has already occurred, a good follow-up of the patient is required. [11][12][13][14][15][16][17][18][19] Recognition of the fact that the renal problem is common and can be easily seen in a short period brings the need for good fluid management and early hospitalization of the patients presenting with severe bloody diarrhea. [33][34][35] Early dialysis in patients with significant rapid impairment can be a good tool for prevention of severe clinical outcomes.…”

Section: Prevention Of Renal Failure: Learning From 2011 E Coli O104mentioning

confidence: 99%

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Renal Failure in the Recent 2011Escherichia coliO104:H4 Outbreak: A Summary on Up-to-Date Data

Wiwanitkit¹

2012

Renal Failure

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The recent 2011 Escherichia coli outbreak in Europe is considered as one of the biggest E. coli outbreak in the modern medical history. Although the induction of renal impairment is well described in E. coli infection, the specific knowledge on E. coli O104:H4 is very limited. To add up to known knowledge, the author hereby summarizes up-to-date information on renal failure among patients in 2011 E. coli O104:H4 outbreak.

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Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial

Cited by 130 publications

References 32 publications

Attending Rounds

Attending Rounds

Lipids, Blood Pressure, Kidney-what was New in 2012?

Renal Failure in the Recent 2011Escherichia coliO104:H4 Outbreak: A Summary on Up-to-Date Data

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