- Hemolytic-uremic syndrome as a complication of infectious diarrhea in children: clinical cases
Hemolytic-uremic syndrome as a complication of infectious diarrhea in children: clinical cases
Modern Pediatrics.Ukraine.2020.3(107):93-98; doi 10.15574/SP.2020.107.93
Pakholchuk T. N.1, Ysachova E. V.1, Silina E. A.1, L.I. Klyatskaya1, O.P. Pakholchuk1, T.B. Matveeva2, V.V. Pechugina2, I.V. Litvinenko3
1Zaporizhzhia State Medical University, Ukraine
2Municipal Institution «Regional Infectious Clinical Hospital» of Zaporizhzhya Regional Council, Ukraine
3Children's City Hospital No 5, Zaporizhzhya, Ukraine
For citation: Pakholchuk TN, Ysachova EV, Silina EA, Klyatskaya LI et al. (2020). Hemolytic-uremic syndrome as a complication of infectious diarrhea in children: clinical cases. Modern Pediatrics. Ukraine. 3(107): 93–98; doi 10.15574/SP.2020.107.93
Article received: Jan 17, 2020. Accepted for publication: Apr 04, 2020.
Hemolytic-uremic syndrome (HUS) is a serious complication of bacterial and viral diarrheal diseases, which is one of the causes of development of acute renal failure in children, and the effectiveness of its treatment and outcomes depend directly on the timeliness of diagnostics.
Aim: To demonstrate the features of hemolytic&uremic syndrome in infants with infectious diarrhea.
Materials and methods. Two cases of GUS associated with diarrheal syndrome were analysed. In the first case manifestation was detected at the background of the rotaviral infection. In the second case — on the background of the toxicosis. Results of the examination, therapy, indicating the complexity of diagnosis and treatment are discussed.
Results and conclusions. In both cases, the disease began with diarrheal syndrome with hemocolitis. In the child with rotaviral infection with toxicosis and hemicolitis, the manifestations of HUS developed on the 4th day of the disease, and in the second child with acute intestinal infection of unexplained etiology with hemocolitis, manifestations of HUS developed on the 6th day of treatment. Subsequently, patients were examined and treated in the conditions of the department of chroniodialysis with hemodialysis. Patients underwent 17 and 14 hemodialysis sessions, respectively. To exclude thrombotic thrombocytopenic purpura (TTP), studies were conducted in Dr. Radger's laboratory for the presence of ADAMTS-13 antibodies. After treatment, children were discharged on the 56th and 51th days of the treatment. In 3 and 6 months after discharge from the hospital, children undergone full control examination, which revealed no deviations from the norm on all previously changed indicators. Their condition is stable. The results of the follow-up of children within 8 months indicate clinical and laboratory remission. During this time, they take ACE inhibitors for nephroprotection. Children remain under clinical observation with periodic monitoring of laboratory parameters over the next 5 years.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Key words: children, toxic-toxicosis, intestinal infection, hemolytic-uremic syndrome
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