Clinical Study on Hemolytic Uremic Syndrome in Children: Review of 23 Cases

Oh, Seung Jin; Yook, Jin Won; Kim, Ji Hong; Kim, Pyung Kil

Abstract

PURPOSE: The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. It is one of the most common cause of acute renal failure in children but few reports are available in Korea. Thus we investigated the 23 patients diagnosed as HUS during last 14 years. METHOD: We retrospectively investigated the etiologic factor, clinical manifestations, laboratory findings, treatment modalities, and final outcomes of the patients. Then patients were divided into two groups according to outcome, and comparison was performed. Group A(8) comprised patients who progressed to end-stage renal disease or expired. Group B(15) comprised patients who completely recovered after dialysis treatment. RESULT: The number of patients aged less than 4 years were 17; between 5 and 10 were 4 and more than 10 were 2. The gende ratio was M:F=2 : 1. The etiologic factors were as follows: acute gastroenteritis in 14 patients including 4 bloody diarrhea, upper respiratory tract infection in 7 patients, and 1 patient with herbal medication. The overall mortality rate was 22%: 2 patients died of CNS complications, 2 patients died of sepsis, and 1 patient died of pulmonary hemorrhage. Group A (Hb 4.8+/-1.2 g/dL) showed lower value in hemoglobin than group B (Hb 6.3+/-1.7 g/dL) during hospital stay (p<0.05), And the time interval between the disease onset and dialysis treatment was significantly longer in group A (11.9+/-9.1 days vs 2.8+/-2.1 days) (p<0.05).
CONCLUSION
Overall mortality rate was 22%. Low hemoglobin value and the prolonged time interval between the disease onset and dialysis treatment were related with poor prognosis. So early diagnosis and appropriate intensive care including dialysis treatment is essential to achieve better outcome in children.