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Hemolytic uremic syndrome associated with glomerular disease
R L Siegler1, E D Brewer, T J Pysher
1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City 84132.
Summary
Secondary hemolytic uremic syndrome (HUS) is rare, often linked to other conditions. This study highlights HUS occurring with glomerular diseases, emphasizing its consideration in nephritic or nephrotic patients with specific symptoms.
Area of Science:
- Nephrology
- Hematology
- Pathology
Background:
- Secondary hemolytic uremic syndrome (HUS) is an uncommon condition.
- It is typically associated with pregnancy, malignancy, severe hypertension, drugs, or collagen vascular diseases.
- Reports of HUS in patients with glomerular disease are rare.
Observation:
- Two cases of secondary HUS in patients with glomerular disease are presented.
- Case 1: A 17-month-old girl with hematuria, nephrotic syndrome, and low C3/C4 levels developed HUS.
- Case 2: A 22-year-old man with a history of minimal change nephrotic syndrome experienced a relapse complicated by HUS.
Findings:
- Kidney biopsy in Case 1 revealed fibrin in glomerular capillaries and cresentic membranoproliferative glomerulonephritis.
- Kidney biopsy in Case 2 showed foot process fusion and glomerular capillary obstruction by fibrin and platelets.
- Both patients presented with thrombocytopenia, microangiopathic hemolytic anemia, and varying degrees of renal impairment.
Implications:
- These cases demonstrate that hemolytic uremic syndrome can occur secondary to other glomerular diseases.
- Consideration of secondary HUS is crucial in nephritic or nephrotic patients presenting with thrombocytopenia and hemolytic anemia.
- Early recognition and diagnosis are vital for appropriate management of HUS in this context.