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Endarterial urokinase in childhood hemolytic uremic syndrome
Insights
Local urokinase infusion did not improve kidney function or preservation in children with hemolytic uremic syndrome (HUS)-related acute renal failure. The study found no evidence of urokinase benefit in treating HUS in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Thrombolytic Therapy
- Renal Medicine
Background:
- Hemolytic uremic syndrome (HUS) can cause acute renal failure with impaired renal perfusion in children.
- Thrombolytic agents like urokinase are sometimes considered for such conditions.
- The efficacy of local urokinase infusion in pediatric HUS is not well-established.
Purpose of the Study:
- To evaluate the effect of intra-arterial urokinase infusion on renal perfusion and function in children with HUS.
- To determine if urokinase preserves renal mass or improves outcomes in pediatric HUS.
Main Methods:
- Unilateral or bilateral renal artery infusion of urokinase in 8 children (0.2-13.0 years) with HUS-related acute renal failure.
- Assessment of renal perfusion via dynamic renal scanning and arteriography.
- Evaluation of divided renal function and renal mass via static renal scanning and kidney examination post-mortem or pre-transplant.
Main Results:
- No immediate improvement in renal perfusion was observed following urokinase infusion.
- Long-term assessment showed no evidence of improved divided renal function in surviving children.
- Kidney examinations revealed no preservation of renal mass attributable to urokinase; one infused kidney was smaller than the untreated kidney.
Conclusions:
- Local urokinase infusion via renal artery had no beneficial effect on the clinical course of HUS in these pediatric patients.
- The treatment did not demonstrate efficacy in improving renal perfusion, function, or renal mass preservation.
- Intra-arterial urokinase is not recommended for treating HUS-related acute renal failure in children based on this study.
Abstract:
Urokinase was given by unilateral infusion for 48-168 hours into the renal arteries of 8 children (0.2 to 13.0 years) with acute renal failure and impaired renal perfusion due to hemolytic uremic syndrome (HUS). Two children subsequently received a bilateral infusion. Immediate changes in renal perfusion were assessed by serial dynamic renal scanning in all patients and by repeat renal arteriography in 5. No improvement clearly attributable to urokinase was observed. In 4 surviving children assessment of divided renal function by static renal scanning 1 to 5 years after presentation showed no evidence of benefit from urokinase. Examination of the kidneys of 2 of the 3 children who died, and one who underwent bilateral nephrectomy prior to renal transplantation, showed no evidence of benefit from urokinase. Examination of the kidneys of 2 of the 3 children who died, and one who underwent bilateral nephrectomy prior to renal transplantation, showed no preservation of renal mass attributable to urokinase; in one of these children the infused kidney was considerably smaller than the untreated kidney. It is concluded that local infusion of urokinase had no beneficial effect on the course of HUS in these children.