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Hemolytic Uremic Syndrome-Induced Acute Kidney Injury Treated via Immunomodulation with the Selective Cytopheretic

H Rhodes Hambrick1,2, Kara Short3, David Askenazi3

  • 1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Blood Purification
|August 22, 2023
PubMed

Insights

Selective cytopheretic device (SCD) therapy shows promise in treating pediatric Shiga-toxin associated-hemolytic uremic syndrome (STEC-HUS). This immunomodulatory treatment improved outcomes in three children with STEC-HUS-induced acute kidney injury (AKI).

Area of Science:

  • Pediatric Nephrology
  • Immunology
  • Critical Care Medicine

Background:

  • Shiga-toxin associated-hemolytic uremic syndrome (STEC-HUS) is a severe condition causing acute kidney injury (AKI) in children.
  • HUS pathophysiology involves activated neutrophils damaging vascular endothelial cells, leading to significant morbidity and mortality.
  • Therapeutic immunomodulation targeting neutrophils may offer a novel treatment approach.

Purpose of the Study:

  • To evaluate the safety and efficacy of the selective cytopheretic device (SCD) in pediatric patients with STEC-HUS.
  • To assess the impact of SCD therapy on multi-organ dysfunction and renal recovery in STEC-HUS.

Main Methods:

  • Three pediatric patients with STEC-HUS requiring continuous renal replacement therapy (CRRT) were treated with the SCD.
  • Patient 1 received 7 days of SCD and CRRT; patients 2 and 3 each received 24 hours of SCD therapy followed by dialysis.

Main Results:

  • The patient treated for 7 days showed gradual recovery of multi-organ dysfunction and normal kidney/hematologic parameters at 60-day follow-up.
  • Both patients treated for 24 hours demonstrated gradual improvement, with normalization or near-normalization of kidney function at 60 days.
  • SCD treatment was well-tolerated with no device-related adverse events.

Conclusions:

  • Selective cytopheretic device (SCD) therapy was associated with improvements in STEC-HUS-induced AKI and associated multisystem organ dysfunction.
  • SCD is a potentially effective and safe immunomodulatory treatment for pediatric STEC-HUS.
  • Further research is warranted to confirm these findings in larger cohorts.
Abstract

Keywords:
Acute kidney injuryContinuous renal replacement therapyImmunomodulationShiga-toxin associated-hemolytic uremic syndrome

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