Hemolytic Uremic syndrome associated with pregnancy: Outcome from acute Kidney Injury

Objective: To report here, case series of women developing acute kidney injury (AKI) in association with hemolytic uremic syndrome (HUS) during pregnancy or within days postpartum. Methods: Subjects for the study reported here comprised of a cohort of 49 women referred from OBGYN and diagnosed having AKI and HUS. AKI was defined according to RIFLE criteria and HUS on basis of hematological, biochemical and histological features. All patients had normal size kidneys on ultrasonography and no previous co- morbidity. Results: From January 2000 – January 2020, 49 such women were admitted/ referred to this facility. The mean age of these patients was 29.02±5.258 years. Two had HUS during pregnancy while rest during postpartum. Majority of women had more than one insults these include hemorrhages, intrauterine deaths, operative measure (lower segment caesarean section). Renal replacement was required in all women. Complete renal recovery was observed in 14 patients, while one died during acute phase of illness. CKD-V developed in 17 patients, 16 patients lost long term follow up, but were dialysis free till last follow up and one left against medical advice during acute phase of illness. Treatment with plasmapheresis revealed significantly better renal recovery (p value 0.03) in this group of patients. Conclusion: AKI with background of Hemolytic Uremic Syndrome (HUS) may remain irreversible in many of these young women. Plasmapheresis should be offered to patients with established diagnosis of HUS. doi: https://doi.org/10.12669/pjms.36.6.2931 How to cite this:Naqvi R. Hemolytic Uremic syndrome associated with pregnancy: Outcome from acute Kidney Injury. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2931 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Acute Kidney Injury with Hemolytic Uremic Syndrome

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd4184 ◽

2021 ◽

Vol 4 (1) ◽

pp. 193-198

Author(s):

Rubina Naqvi ◽

Khawar Abbas ◽

Syed Fazal Akhtar

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Uremic Syndrome ◽

Case Series ◽

Kidney Injury ◽

Febrile Illness ◽

Renal Recovery ◽

P Value ◽

Co Morbidity ◽

Uremic Syndrome

We report here, case series of patients with acute kidney injury (AKI) developing in associationwith hemolytic uremic syndrome (HUS). Different causes of HUS and outcome of patients in this group of patients is aimed to be reported. Patients and Methods: subjects for the study reported here comprised of a cohort of 105 patients admitted with the diagnosis of AKI due to HUS. AKI was defined according to RIFLE criteria and HUS on basis of hematological, biochemical and/or histological features. All patients had normal size kidneys on ultrasonography and no previous co- morbidity. Results: One hundred and five patients with AKI due to HUS were brought to this institute from January 2000 - July 2019; among these 76 were females, mean age of these patients was 27.83±10.50 years. Causes of HUS were febrile illness, with or without diarrhea, diarrhea alone, pregnancy related complications and one each from snake bite, HCV infection / IFN therapy and use of combination of drugs. In pregnancy related HUS one patient had HUS during pregnancy while rest were during postpartum. Renal replacement was required in 95.23 % patients. Complete renal recovery was observed in 22 patients, while 15 died during acute phase of illness. CKD-V developed in 24 patients, 41 patients lost long term follow up, but were dialysis free till last follow up. Treatment with plasmapheresis revealed significantly better renal recovery (p value 0.026) in this group of patients. Conclusion: HUS can be severe life threatening disease; AKI with background of HUS may remain irreversible in many of these patients. Plasmapheresis should be offered to patients with established diagnosis of HUS.

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Acute Kidney Injury in Children: Etiologies and Results

Journal of Clinical Case Reports and Studies ◽

10.31579/2690-8808/008 ◽

2020 ◽

Vol 1 (2) ◽

pp. 01-05

Author(s):

Seba Atmane

Keyword(s):

Acute Kidney Injury ◽

Peritoneal Dialysis ◽

Hemolytic Uremic Syndrome ◽

Kidney Function ◽

Emergency Treatment ◽

Kidney Injury ◽

Obstructive Nephropathy ◽

Normal Kidney ◽

Uremic Syndrome

The aim of the study is to show the etiologies and the follow-up of our AKI cases. This was conducted in our hospital, between 2015 and 2018. During this period we included 26 children with AKI (64% femals) with a median age of 7 years (range 40 days to 15 years). In the majority of the cases revealed by digestive signs and that related to the etiology of AKI (Hemolytic Uremic Syndrome post diarrhea). In our study, 44% of the patients have thrombocytopenia associated with AKI. The etiology of AKI is : Nephropathy glomerular in 37% hemolytic and uremic syndrom in 54% and obstructive nephropathy in 9%. Patients survived in 92 % of the cases and 58% of them have recovered normal kidney function, 7% of death. Peritoneal dialysis is the most commonly used emergency treatment for AKI in children at a frequency of 37%., hemodialysis was used less.

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Case series of secondary thrombotic microangiopathy in children with multisystem inflammatory syndrome associated with COVID-19

Russian Medical Inquiry ◽

10.32364/2587-6821-2021-5-11-773-777 ◽

2021 ◽

Vol 5 (11) ◽

pp. 773-777

Author(s):

D.V. Novikov ◽

◽

T.S. Sabinina ◽

T.V. Shalbarova ◽

O.L. Chugunova ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Uremic Syndrome ◽

Thrombotic Microangiopathy ◽

World Literature ◽

Case Series ◽

Kidney Injury ◽

Number Of Patients ◽

Uremic Syndrome ◽

Coronavirus Infection ◽

Inflammatory Syndrome

Thrombotic microangiopathy (TMA) is one of the main links in the pathogenesis of multisystem inflammatory syndrome in children (MIS-C) associated with a new coronavirus infection caused by SARS-Cov-2 (COVID-19). In the setting of an increasing number of patients with hemolytic uremic syndrome (HUS) during the COVID-19 pandemic, 5 out of 7 cases of HUS (according to the Khimki Regional Hospital) in children revealed the association between acute kidney injury (AKI) and history of COVID-19. Also, there were recorded laboratory markers of systemic inflammation, the relevant criteria for the diagnosis of MIS-C associated with SARS-CoV-2. The article presents a clinical analysis of the case series concerning HUS, during which a comparison with the world literature data was conducted. It was proposed to consider this pathology in children as secondary thrombotic microangiopathy (TMA) in the setting of new coronavirus infection, similar to secondary TMA, developed due to exposure to HIV. During the COVID-19 pandemic, it is extremely important to establish the association between the TMA and the experienced COVID-19 in children for the therapy correction and further follow-up of patients after discharge from the hospital. KEYWORDS: new coronavirus infection, SARS-CoV-2, COVID-19, multisystem inflammatory syndrome, secondary thrombotic microangiopathy, hemolytic-uremic syndrome, acute kidney injury. FOR CITATION: Novikov D.V., Sabinina T.S., Shalbarova T.V. et al. Case series of secondary thrombotic microangiopathy in children with multisystem inflammatory syndrome associated with COVID-19. Russian Medical Inquiry. 2021;5(11):773–777 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-773-777.

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Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Kidney Diseases ◽

10.1159/000507668 ◽

2020 ◽

Vol 6 (6) ◽

pp. 414-421

Author(s):

Youlu Zhao ◽

Junwen Huang ◽

Tao Su ◽

Zhikai Yang ◽

Xizi Zheng ◽

...

Keyword(s):

Acute Kidney Injury ◽

Thrombotic Microangiopathy ◽

Tubulointerstitial Nephritis ◽

Late Onset ◽

Drug Hypersensitivity ◽

Oral Prednisone ◽

Kidney Injury ◽

Renin Angiotensin System ◽

Renal Recovery

Background: The syndrome of tubulointerstitial nephritis and uveitis (TINU) is an uncommon and multisystemic autoimmune disorder. This review reports a rare case of TINU being superimposed on thrombotic microangiopathy (TMA) and, by comparing with the available literature, also summarizes the clinical features, associated conditions, treatment, and outcome of patients with TINU. Summary: Herein, we report the case of a 37-year-old male patient with acute kidney injury (AKI) clinicopathologically identified as malignant hypertension-induced TMA superimposed by acute tubulointerstitial nephritis, which was suspected to be related to drug hypersensitivity. After treatment with oral prednisone combined with a renin-angiotensin system inhibitor, the patient achieved partial renal recovery and was withdrawn from hemodialysis. Recurrent AKI concomitant with new-onset asymptomatic uveitis was detected during routine clinical follow-up after cessation of prednisone. TINU was then diagnosed, and prednisone followed by cyclophosphamide was prescribed. The patient achieved better renal recovery than in the first round of treatment and maintained stable renal function afterward. By reviewing the literature, 36 cases were reported as TINU superimposed on other conditions, including thyroiditis, osteoarthropathy, and sarcoid-like noncaseating granulomas. Key messages: TINU could be complicated by many other conditions, among which TMA is very rare. When presented as AKI, kidney biopsy is important for differential diagnosis. The case also shows that recurrent AKI with concomitant uveitis after prednisone withdrawal strongly suggested the need for long-term follow-up and elongated prednisone therapy for TINU syndrome.

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Eculizumab Modifies Outcomes in Adults with Atypical Hemolytic Uremic Syndrome with Acute Kidney Injury

American Journal of Nephrology ◽

10.1159/000492865 ◽

2018 ◽

Vol 48 (3) ◽

pp. 225-233 ◽

Cited By ~ 4

Author(s):

Mercedes Cao ◽

Bruna N. Leite ◽

Tamara Ferreiro ◽

María Calvo ◽

Constantino Fernández ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Uremic Syndrome ◽

Kidney Function ◽

Case Reports ◽

Atypical Hemolytic Uremic Syndrome ◽

Kidney Injury ◽

Complete Recovery ◽

Genetic Abnormalities ◽

Uremic Syndrome ◽

Meta Analyses

Background: Atypical hemolytic uremic syndrome (aHUS) is a rare disease associated with congenital or acquired genetic abnormalities that result in uncontrolled complement activation, leading to thrombotic microangiopathy and kidney failure. Until recently, the only treatment was plasma exchange or plasma infusion (PE/PI), but 60% of patients died or had permanent kidney damage despite treatment. Eculizumab, a complement inhibitor, has shown promising results in aHUS. However, data are mainly extracted from case reports or studies of heterogeneous cohorts, and no direct comparison with PE/PI is available. Methods: An observational retrospective study of adult, dialysis-dependent aHUS patients with acute kidney injury (AKI) who were treated with either PE/PI alone or with second-line eculizumab in our center. We compared the effect of PE/PI and eculizumab on kidney function, hypertension, proteinuria, hematologic values, relapse, and death. Results: Thirty-one patients were included (females, 18; sporadic aHUS, 29; mean age, 46 ± 20 years). Twenty-six patients were treated with PE/PI alone, and 5 were deemed to be plasma-resistant and received eculizumab after stopping PE/PI. Among patients receiving eculizumab, 80% attained complete recovery of kidney function, 100% stopped dialysis, 20% had decreased proteinuria, and no patient relapsed (vs. 38.5, 50, 15.4, and 11.5%, respectively, of patients receiving only PE/PI). At 1-year of follow-up, no deaths had occurred in either group. Conclusion: Eculizumab shows greater efficacy than PE/PI alone for the treatment of adult aHUS patients with AKI. Prospective studies and meta-analyses are warranted to confirm our findings and set guidelines for treatment, monitoring, and maintenance.

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Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0264 ◽

2019 ◽

Vol 41 (4) ◽

pp. 534-538 ◽

Cited By ~ 2

Author(s):

Guilherme Palhares Aversa Santos ◽

Luis Gustavo Modelli de Andrade ◽

Mariana Farina Valiatti ◽

Mariana Moraes Contti ◽

Hong Si Nga ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Transplantation ◽

Case Series ◽

Kidney Injury ◽

Organ Donors ◽

Retrospective Case ◽

Proportional Increase ◽

Deceased Donors

ABSTRACT Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.

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Novel presentation of Plasmodium vivax malaria with acute kidney injury and hemolytic uremic syndrome

Clinical Queries Nephrology ◽

10.1016/j.cqn.2016.02.001 ◽

2015 ◽

Vol 4 (3-4) ◽

pp. 34-37

Author(s):

Mohan P. Patel ◽

Prakash P. Ugale ◽

Abhijeet B. Jagtap ◽

Sandip T. Chaudhari ◽

Pitambar N. Dighore

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Uremic Syndrome ◽

Plasmodium Vivax ◽

Vivax Malaria ◽

Kidney Injury ◽

Plasmodium Vivax Malaria ◽

Uremic Syndrome

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Collapsing glomerulopathy and hemolytic uremic syndrome associated with falciparum malaria: completely reversible acute kidney injury

Journal of Parasitic Diseases ◽

10.1007/s12639-012-0164-6 ◽

2012 ◽

Vol 37 (2) ◽

pp. 286-290 ◽

Cited By ~ 5

Author(s):

Vivek Balkrishna Kute ◽

Hargovind L. Trivedi ◽

Aruna V. Vanikar ◽

Pankaj R. Shah ◽

Manoj R. Gumber ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Uremic Syndrome ◽

Falciparum Malaria ◽

Kidney Injury ◽

Collapsing Glomerulopathy ◽

Uremic Syndrome

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P0602CLINICAL PATTERN, RENAL RECOVERY AND PATIENT OUTCOMES AFTER ACUTE KIDNEY INJURY IN ADULTS IN AN EMERGING COUNTRY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0602 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Arunkumar Subbiah ◽

Sanjay Kumar Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Hospital Mortality ◽

Kidney Injury ◽

Hospitalized Patients ◽

Renal Recovery ◽

Common Source ◽

Partial Recovery

Abstract Background and Aims Acute Kidney Injury (AKI) is an important determinant of outcome in hospitalized patients. Further, there is a risk for development of Chronic Kidney Disease (CKD) in the future. Though the long-term impact of AKI has been studied in developed countries, there is a paucity of data in this area from the Indian subcontinent. This single-centre study aimed to assess the pattern, clinical spectrum, short-term and long-term outcomes of AKI. Method In this prospective observational cohort study, detailed demographic and clinical data at presentation, during hospital stay and follow-up at 1, 3, 6 and 12 months after discharge were obtained prospectively for a cohort of patients with AKI. Both community (CAAKI) and hospital acquired AKI (HAAKI) were included. Patient with pre-existing CKD were excluded. Outcome variables examined were in-hospital mortality, renal function at discharge and on follow-up after discharge from hospital. Results In our study cohort with 476 patients, majority of the cases were CAAKI (395, 83%). The mean age at presentation was 44.8 ± 18.7 years. Medical causes (84%) contributed to the majority of AKI while the remaining were due to surgical (10%) and obstetrical (6%) causes. Sepsis (176/476; 36.9%) was the most common cause of AKI. The most common source for sepsis was respiratory (41%) followed by urological source (18.7%). The in-hospital mortality rate for patients with AKI was 38%. Age >60 years (HR = 1.51; 95% CI, 1.11 – 2.07), oliguria (HR = 1.48; 95% CI, 1.05 – 2.10), need for ventilator (HR = 2.45; 95% CI, 1.36 – 4.41) and/or inotropes (HR = 14.4; 95% CI, 6.28 – 33.05) were predictors of mortality. At discharge, 146 (30.7%) patients had complete renal recovery, while 149 (31.3%) had partial renal recovery. Oliguria (p < 0.001), hypoalbuminemia (p = 0.001) and need for renal replacement therapy (RRT) (p = 0.01) were significantly associated with partial recovery. Of the 295 patients on follow-up at discharge, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 33 (11.2%) were lost to follow up; 47(15.9%) patients developed CKD of which 6 (2%) were dialysis dependent. Elderly patients, higher AKIN stage with oliguria and those requiring RRT were more likely to develop CKD. Among these, the need for in-hospital RRT was the single most important factor predicting the risk of CKD (OR 1.77, 95% CI, 1.12-2.78). Conclusion In conclusion, our data shows that AKI in hospitalized patients still has high mortality in emerging countries like India. Though a fairly good percentage of cases recovered, there is a definite risk of CKD development, especially in patients who required RRT during hospitalization.

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