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A pediatric case with hemolytic uremic syndrome associated with COVID-19, which progressed to end-stage kidney
Serra Sürmeli Döven1, Esra Danacı Vatansever1, Yasemin Yuyucu Karabulut2
1Department of Pediatric Nephrology, Faculty of Medicine, Mersin University, Mersin, Türkiye.
Insights
Coronavirus disease 2019 (COVID-19) can trigger hemolytic uremic syndrome (HUS) relapses in children, potentially leading to end-stage kidney disease. This case highlights the critical link between COVID-19 and pediatric HUS progression.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Hemolytic uremic syndrome (HUS) is a significant cause of acute kidney injury in children.
- Emerging evidence suggests a potential link between coronavirus disease 2019 (COVID-19) and HUS development.
- This study focuses on a pediatric case of HUS associated with COVID-19, detailing its progression to end-stage kidney disease.
Observation:
- A previously healthy 13-year-old female presented with symptoms of fever and vomiting, later diagnosed with COVID-19.
- Initial investigations revealed Coombs-negative hemolytic anemia, thrombocytopenia, and renal impairment.
- Despite initial improvement in anemia and thrombocytopenia, persistent renal impairment and a subsequent HUS recurrence were observed, both associated with COVID-19 infection.
Findings:
- Renal biopsy findings were consistent with both HUS and COVID-19.
- Plasma exchange therapy improved kidney function during the HUS relapse.
- Eculizumab treatment prevented recurrence of anemia and thrombocytopenia but did not resolve persistent renal impairment, ultimately leading to end-stage kidney disease diagnosis.
Implications:
- COVID-19 infection may precipitate HUS relapses in susceptible pediatric patients.
- The association between COVID-19 and HUS can lead to severe renal sequelae, including chronic kidney disease.
- Further investigation is warranted to elucidate the underlying mechanisms connecting COVID-19 and HUS.
Background:
Hemolytic uremic syndrome (HUS) is a serious cause of acute kidney injury in children. There is a suggestion that coronavirus disease 2019 (COVID-19) may be a trigger for HUS. In this study, we present a pediatric case diagnosed with HUS associated with COVID-19, which progressed to end-stage kidney disease.
Case:
A previously healthy 13-year-old girl with fever and vomiting was referred to our hospital. Laboratory investigations revealed direct Coombs-negative hemolytic anemia, thrombocytopenia and renal impairment accompanied by COVID-19 infection. Although anemia and thrombocytopenia showed improvement on the seventh day after admission, the renal impairment persisted. The histopathological findings of a renal biopsy were compatible with both HUS and COVID-19. One month later, the patient had a recurrence of HUS, again testing positive for COVID-19. Kidney function improved with plasma exchange therapy. Eculizumab treatment was recommenced after COVID-19 PCR became negative. Anemia and thrombocytopenia did not recur with eculizumab, while renal impairment persisted. Eculizumab was discontinued after three months when genetic analysis for HUS was negative. Subsequently, the patient was diagnosed with end-stage kidney disease.
Conclusions:
COVID-19 can be associated with HUS relapses, leading to chronic kidney disease. Further studies should investigate the mechanism of HUS associated with COVID-19.
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