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Hemolytic uremic syndrome in children in northern India
R N Srivastava1, A Moudgil, A Bagga
1Department of Pediatrics, All India Institute of Medical Sciences New Delhi.
Insights
Hemolytic uremic syndrome (HUS) in Indian children, often following dysentery, leads to severe kidney damage and a high mortality rate. Early identification and supportive care are crucial for managing this pediatric condition.
Area of Science:
- Pediatrics
- Nephrology
- Infectious Diseases
Background:
- Hemolytic uremic syndrome (HUS) is a severe condition affecting children.
- HUS is a significant cause of acute renal failure in pediatric populations.
Purpose of the Study:
- To analyze the clinical characteristics, causes, and outcomes of HUS in children in northern India.
- To identify factors associated with mortality in pediatric HUS cases.
Main Methods:
- Retrospective analysis of 73 pediatric HUS patients treated between 1980 and 1988.
- Clinical data, stool cultures, blood urea levels, coagulation profiles, and renal biopsies were reviewed.
Main Results:
- Dysentery preceded HUS in 80% of cases, with Shigella species identified in stool cultures.
- Severe renal involvement (anuria/oliguria) was common, and renal cortical necrosis was observed in 40% of biopsied patients.
- The overall mortality rate was 60%, linked to renal failure duration and cortical necrosis.
Conclusions:
- Pediatric HUS in northern India is predominantly linked to dysentery, likely shigellosis.
- The condition is associated with significant renal damage and a high mortality rate.
- Supportive care, including transfusions and dialysis, is the primary management strategy.
Abstract:
We observed 73 patients with the hemolytic uremic syndrome (HUS) in 9 years (1980-1988), comprising 34% of patients with acute renal failure treated over the same period. There were 53 boys and 20 girls; 59% were below the age of 2 years and 33% between 2 and 5 years. Acute, usually severe dysentery, responding poorly to various antibiotics, was the prodromal illness in 80%, whereas 12% had watery diarrhea. Most patients had severe renal involvement with anuria in 56% and oliguria in 30%. A polymorphonuclear leukocytosis was present in 85% of cases, but had no correlation with the highest levels of blood urea. Coagulation abnormalities suggesting consumption coagulopathy were found in 24 of 30 cases. The results of stool culture showed Shigella species in 7 cases and nontyphoidal Salmonella in 9. Escherichia coli were isolated in 11 cases, but were not further characterized. Renal biopsy showed total or patchy cortical necrosis in 20 of 50 cases. The patients were managed with supportive care, including transfusion of fresh blood or plasma and dialysis as required. The mortality was 60%, being chiefly related to the duration of renal failure and presence of renal cortical necrosis, whereas persistent dysentery and infections were complicating factors. The presence of convulsions and coagulation defects had no relation to the outcome. Our observations indicate that HUS in children in northern India is mostly related to dysentery, likely to be shigellosis, and is usually associated with severe renal damage and a high death rate.