Hemolytic-uremic syndrome medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of therapy for [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] [[Hemolytic-uremic syndrome|(HUS)]] is supportive therapy. [[Antibiotic therapy]] is not recommended among patients with [[Hemolytic-uremic syndrome|HUS]]. Hydration and [[intravenous]] ([[IV]]) [[isotonic]] [[Saline (medicine)|saline]] | The mainstay of therapy for [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] [[Hemolytic-uremic syndrome|(HUS)]] is supportive therapy. [[Antibiotic therapy]] is not recommended among patients with [[Hemolytic-uremic syndrome|HUS]]. Hydration and [[intravenous]] ([[IV]]) [[isotonic]] [[Saline (medicine)|saline]] replacment decrease the risk of [[hemolytic-uremic syndrome]] [[HUS|(HUS)]]. Patients with [[Hemolytic-uremic syndrome|HUS]] who have significant clinical bleeding or who require an invasive [[procedure]] should receive [[platelet]] [[transfusions]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*The mainstay of therapy for [[Hemolytic-uremic syndrome|HUS]] is supportive [[therapy]] and almost [[HUS]] | *The mainstay of therapy for [[Hemolytic-uremic syndrome|HUS]] is supportive [[therapy]] and almost all cases of [[HUS]] are self-limited.<ref>{{Cite journal | ||
| author = [[Silviu Grisaru]] | | author = [[Silviu Grisaru]] | ||
| title = Management of hemolytic-uremic syndrome in children | | title = Management of hemolytic-uremic syndrome in children | ||
| Line 17: | Line 17: | ||
| doi = 10.2147/IJNRD.S41837 | | doi = 10.2147/IJNRD.S41837 | ||
| pmid = 24966691 | | pmid = 24966691 | ||
}}</ref> However any patient suspected of [[Hemolytic-uremic syndrome|HUS]] should be referred to a kidney center | }}</ref> However any patient suspected of [[Hemolytic-uremic syndrome|HUS]] should be referred to a kidney center or [[nephrology]] unit or be managed in an [[Intensive care medicine|intensive care unit]]. | ||
*[[Antibiotic therapy]] is not recommended among patients with E. coli O157:H7 infection increases risk of [[Hemolytic-uremic syndrome|HUS]] | *[[Antibiotic therapy]] is not recommended among patients with E. coli O157:H7 infection. This increases the risk of [[Hemolytic-uremic syndrome|HUS]]. However there are some antibiotics that decrease the risk of [[Hemolytic-uremic syndrome|HUS]] such as [[quinolones]].<ref>{{Cite journal | ||
| author = [[C. S. Wong]], [[S. Jelacic]], [[R. L. Habeeb]], [[S. L. Watkins]] & [[P. I. Tarr]] | | author = [[C. S. Wong]], [[S. Jelacic]], [[R. L. Habeeb]], [[S. L. Watkins]] & [[P. I. Tarr]] | ||
| title = The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections | | title = The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections | ||
| Line 73: | Line 73: | ||
| pmid = 10604643 | | pmid = 10604643 | ||
}}</ref> | }}</ref> | ||
*[[Empiric therapy|Empiric]] [[antibiotic]] [[therapy]] such as [[cephalosporins]] for invasive [[Pneumococcal infections|pneumococcal]] disease should be used | *[[Empiric therapy|Empiric]] [[antibiotic]] [[therapy]] such as [[cephalosporins]] for invasive [[Pneumococcal infections|pneumococcal]] disease should be used following culture results. | ||
*[[Recombinant]] [[human]] [[soluble]] [[thrombomodulin]] (rTM)<ref>{{Cite journal | *[[Recombinant]] [[human]] [[soluble]] [[thrombomodulin]] (rTM)<ref>{{Cite journal | ||
| author = [[Yukihiko Kawasaki]], [[Kazuhide Suyama]], [[Atsushi Ono]], [[Tomoko Oikawa]], [[Shinichiro Ohara]], [[Yuichi Suzuki]], [[Nobuko Sakai]] & [[Mitsuaki Hosoya]] | | author = [[Yukihiko Kawasaki]], [[Kazuhide Suyama]], [[Atsushi Ono]], [[Tomoko Oikawa]], [[Shinichiro Ohara]], [[Yuichi Suzuki]], [[Nobuko Sakai]] & [[Mitsuaki Hosoya]] | ||
| Line 118: | Line 118: | ||
| pmid = 15728781 | | pmid = 15728781 | ||
}}</ref> | }}</ref> | ||
*[[Eculizumab]] is used to treat | *[[Eculizumab]] is used to treat atypical [[Hemolytic-uremic syndrome|HUS]].<ref>{{Cite journal | ||
| author = [[Rawaa Ebrahem]], [[Salam Kadhem]] & [[Quoc Truong]] | | author = [[Rawaa Ebrahem]], [[Salam Kadhem]] & [[Quoc Truong]] | ||
| title = Treatment of Atypical Hemolytic-Uremic Syndrome in the Era of Eculizumab | | title = Treatment of Atypical Hemolytic-Uremic Syndrome in the Era of Eculizumab | ||
| Line 133: | Line 133: | ||
* '''Acute kidney injury''' | * '''Acute kidney injury''' | ||
** First | ** First discontinue medicines that have [[renal]] [[toxicity]].<ref>{{Cite journal | ||
| author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Jonathan C. Craig]], [[Greta Ridley]] & [[Elisabeth M. Hodson]] | | author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Jonathan C. Craig]], [[Greta Ridley]] & [[Elisabeth M. Hodson]] | ||
| title = Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials | | title = Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials | ||
| Line 220: | Line 220: | ||
| pmid = 792781 | | pmid = 792781 | ||
}}</ref> | }}</ref> | ||
** | ** Patients who undergoi hemodialysis, [[transfusions]] sh<nowiki/>ould be given during [[dialysis]] to minimize the risks of [[hypervolemia]]<nowiki/> and [[hyperkalemia]].<ref>{{Cite journal | ||
| author = [[Hoon Young Choi]] & [[Sung Kyu Ha]] | | author = [[Hoon Young Choi]] & [[Sung Kyu Ha]] | ||
| title = Potassium balances in maintenance hemodialysis | | title = Potassium balances in maintenance hemodialysis | ||
Revision as of 02:28, 21 December 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]
Overview
The mainstay of therapy for hemolytic uremic syndrome (HUS) is supportive therapy. Antibiotic therapy is not recommended among patients with HUS. Hydration and intravenous (IV) isotonic saline replacment decrease the risk of hemolytic-uremic syndrome (HUS). Patients with HUS who have significant clinical bleeding or who require an invasive procedure should receive platelet transfusions.
Medical Therapy
- The mainstay of therapy for HUS is supportive therapy and almost all cases of HUS are self-limited.[1] However any patient suspected of HUS should be referred to a kidney center or nephrology unit or be managed in an intensive care unit.
- Antibiotic therapy is not recommended among patients with E. coli O157:H7 infection. This increases the risk of HUS. However there are some antibiotics that decrease the risk of HUS such as quinolones.[2][3][4][5]
- Heparin, anti-platelet agents, immunoadsorption, thrombomodulin (rhTM).[6]
- Fosfomycin should be started within 48-72 hours of the patient's presentation of HUS.[7]
- Empiric antibiotic therapy such as cephalosporins for invasive pneumococcal disease should be used following culture results.
- Recombinant human soluble thrombomodulin (rTM)[8] is a novel medicine that use to treat children with HUS.[9][10][11]
- Eculizumab is used to treat atypical HUS.[12]
HUS
- Acute kidney injury
- First discontinue medicines that have renal toxicity.[13]
- Fluid replacement is the mainstay of treatment.[14]
- Majority of patients have normokalemia.[15]
- Hydration and intravenous (IV) isotonic saline replacment decrease risk of hemolytic-uremic syndrome (HUS) and prevent of further complications.[16]
- Monitor hydration and electrolytes during infection by ample fluid therapy effects on short and long-term disease outcomes.[17]
- Indications for dialysis in children with HUS are similar to those in children with other forms of acute kidney injury(AKI).[18]
- Anemia
- Recommendation for transfuse packed red blood cells (RBC):[19]
- Hemoglobin <6 g/dL
- Hematocrit < 18
- Transfusion should be done slowly and patients should be obsereved closely.
- Monitor their outputs plasma potassium to prevent hyperkalemia.
- The goal of Hgb level after transfiution is between 8-9 g/dL.
- Do not try to normalize the hemoglobin as it may lead to heart failure, pulmonary edema and hypertension due to volume overload.[20]
- Patients who undergoi hemodialysis, transfusions should be given during dialysis to minimize the risks of hypervolemia and hyperkalemia.[21]
- Recommendation for transfuse packed red blood cells (RBC):[19]
- Thrombocytopenia
- Hypertension
- At the first indication of hypertension fluids should be restricted. Dialysis is more effective than diuretics.
- Calcium channel blockers should be used as the initial choice of antihypertensive agents and after this phase antihypertensive therapy should be changed to ACE inhibitors in patients who appear to have long-term renal sequelae.[23]
- Neurologic dysfunction
- Patients with serious neurologic dysfunction should be radiological imaging performed to assess CNS involvement.[24]Seizures are treated with antiepileptic agents. Plasma therapy often use among patients with severe CNS involvement.[25]
References
- ↑ Silviu Grisaru (2014). "Management of hemolytic-uremic syndrome in children". International journal of nephrology and renovascular disease. 7: 231–239. doi:10.2147/IJNRD.S41837. PMID 24966691.
- ↑ C. S. Wong, S. Jelacic, R. L. Habeeb, S. L. Watkins & P. I. Tarr (2000). "The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections". The New England journal of medicine. 342 (26): 1930–1936. doi:10.1056/NEJM200006293422601. PMID 10874060. Unknown parameter
|month=ignored (help) - ↑ Nasia Safdar, Adnan Said, Ronald E. Gangnon & Dennis G. Maki (2002). "Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis". JAMA. 288 (8): 996–1001. PMID 12190370. Unknown parameter
|month=ignored (help) - ↑ G. Z. Panos, G. I. Betsi & M. E. Falagas (2006). "Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?". Alimentary pharmacology & therapeutics. 24 (5): 731–742. doi:10.1111/j.1365-2036.2006.03036.x. PMID 16918877. Unknown parameter
|month=ignored (help) - ↑ Paul N. Goldwater & Karl A. Bettelheim (2012). "Treatment of enterohemorrhagic Escherichia coli (EHEC) infection and hemolytic uremic syndrome (HUS)". BMC medicine. 10: 12. doi:10.1186/1741-7015-10-12. PMID 22300510. Unknown parameter
|month=ignored (help) - ↑ . doi:10.1097/INF.0b013e31823096a8. Check
|doi=value (help). Missing or empty|title=(help) - ↑ K. Ikeda, O. Ida, K. Kimoto, T. Takatorige, N. Nakanishi & K. Tatara (1999). "Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157:H7 infection". Clinical nephrology. 52 (6): 357–362. PMID 10604643. Unknown parameter
|month=ignored (help) - ↑ Yukihiko Kawasaki, Kazuhide Suyama, Atsushi Ono, Tomoko Oikawa, Shinichiro Ohara, Yuichi Suzuki, Nobuko Sakai & Mitsuaki Hosoya (2013). "Efficacy of recombinant human soluble thrombomodulin for childhood hemolytic uremic syndrome". Pediatrics international : official journal of the Japan Pediatric Society. 55 (5): e139–e142. doi:10.1111/ped.12165. PMID 24134770. Unknown parameter
|month=ignored (help) - ↑ Takashi Honda, Shohei Ogata, Eri Mineo, Yukako Nagamori, Shinya Nakamura, Yuki Bando & Masahiro Ishii (2013). "A novel strategy for hemolytic uremic syndrome: successful treatment with thrombomodulin alpha". Pediatrics. 131 (3): e928–e933. doi:10.1542/peds.2012-1466. PMID 23382444. Unknown parameter
|month=ignored (help) - ↑ Lindsay S. Keir, Stephen D. Marks & Jon Jin Kim (2012). "Shigatoxin-associated hemolytic uremic syndrome: current molecular mechanisms and future therapies". Drug design, development and therapy. 6: 195–208. doi:10.2147/DDDT.S25757. PMID 22888220.
- ↑ Marina Noris & Giuseppe Remuzzi (2005). "Hemolytic uremic syndrome". Journal of the American Society of Nephrology : JASN. 16 (4): 1035–1050. doi:10.1681/ASN.2004100861. PMID 15728781. Unknown parameter
|month=ignored (help) - ↑ Rawaa Ebrahem, Salam Kadhem & Quoc Truong (2017). "Treatment of Atypical Hemolytic-Uremic Syndrome in the Era of Eculizumab". Cureus. 9 (3): e1111. doi:10.7759/cureus.1111. PMID 28439485. Unknown parameter
|month=ignored (help) - ↑ Mini Michael, Elizabeth J. Elliott, Jonathan C. Craig, Greta Ridley & Elisabeth M. Hodson (2009). "Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials". American journal of kidney diseases : the official journal of the National Kidney Foundation. 53 (2): 259–272. doi:10.1053/j.ajkd.2008.07.038. PMID 18950913. Unknown parameter
|month=ignored (help) - ↑ Mini Michael, Elizabeth J. Elliott, Greta F. Ridley, Elisabeth M. Hodson & Jonathan C. Craig (2009). "Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura". The Cochrane database of systematic reviews (1): CD003595. doi:10.1002/14651858.CD003595.pub2. PMID 19160220. Unknown parameter
|month=ignored (help) - ↑ M. Glatstein, Miguel; Snehal, Vala; Amir Ahmad, Syed; Scolnik, Dennis (2012). "Are potassium levels in children with hemolytic uremic syndrome predictive of outcome?". Open Journal of Pediatrics. 02 (04): 264–267. doi:10.4236/ojped.2012.24043. ISSN 2160-8741.
- ↑ Julie A. Ake, Srdjan Jelacic, Marcia A. Ciol, Sandra L. Watkins, Karen F. Murray, Dennis L. Christie, Eileen J. Klein & Phillip I. Tarr (2005). "Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion". Pediatrics. 115 (6): e673–e680. doi:10.1542/peds.2004-2236. PMID 15930195. Unknown parameter
|month=ignored (help) - ↑ Gianluigi Ardissino, Francesca Tel, Ilaria Possenti, Sara Testa, Dario Consonni, Fabio Paglialonga, Stefania Salardi, Nicolo Borsa-Ghiringhelli, Patrizia Salice, Silvana Tedeschi, Pierangela Castorina, Rosaria Maria Colombo, Milena Arghittu, Laura Daprai, Alice Monzani, Rosangela Tozzoli, Maurizio Brigotti & Erminio Torresani (2016). "Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome". Pediatrics. 137 (1). doi:10.1542/peds.2015-2153. PMID 26644486. Unknown parameter
|month=ignored (help) - ↑ Jennifer G. Jetton, Louis J. Boohaker, Sidharth K. Sethi, Sanjay Wazir, Smriti Rohatgi, Danielle E. Soranno, Aftab S. Chishti, Robert Woroniecki, Cherry Mammen, Jonathan R. Swanson, Shanty Sridhar, Craig S. Wong, Juan C. Kupferman, Russell L. Griffin & David J. Askenazi (2017). "Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study". The Lancet. Child & adolescent health. 1 (3): 184–194. doi:10.1016/S2352-4642(17)30069-X. PMID 29732396. Unknown parameter
|month=ignored (help) - ↑ J. R. Brandt, L. S. Fouser, S. L. Watkins, I. Zelikovic, P. I. Tarr, V. Nazar-Stewart & E. D. Avner (1994). "Escherichia coli O 157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers". The Journal of pediatrics. 125 (4): 519–526. PMID 7931869. Unknown parameter
|month=ignored (help) - ↑ B. S. Kaplan, P. D. Thomson & J. P. de Chadarevian (1976). "The hemolytic uremic syndrome". Pediatric clinics of North America. 23 (4): 761–777. PMID 792781. Unknown parameter
|month=ignored (help) - ↑ Hoon Young Choi & Sung Kyu Ha (2013). "Potassium balances in maintenance hemodialysis". Electrolyte & blood pressure : E & BP. 11 (1): 9–16. doi:10.5049/EBP.2013.11.1.9. PMID 23946760. Unknown parameter
|month=ignored (help) - ↑ Phillip I. Tarr, Carrie A. Gordon & Wayne L. Chandler (2005). "Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome". Lancet (London, England). 365 (9464): 1073–1086. doi:10.1016/S0140-6736(05)71144-2. PMID 15781103. Unknown parameter
|month=ignored (help) - ↑ Phillip I. Tarr, Carrie A. Gordon & Wayne L. Chandler (2005). "Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome". Lancet (London, England). 365 (9464): 1073–1086. doi:10.1016/S0140-6736(05)71144-2. PMID 15781103. Unknown parameter
|month=ignored (help) - ↑ Andreas Greinacher, Sigrun Friesecke, Peter Abel, Alexander Dressel, Sylvia Stracke, Michael Fiene, Friedlinde Ernst, Kathleen Selleng, Karin Weissenborn, Bernhard M. W. Schmidt, Mario Schiffer, Stephan B. Felix, Markus M. Lerch, Jan T. Kielstein & Julia Mayerle (2011). "Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial". Lancet (London, England). 378 (9797): 1166–1173. doi:10.1016/S0140-6736(11)61253-1. PMID 21890192. Unknown parameter
|month=ignored (help) - ↑ Mini Michael, Elizabeth J. Elliott, Greta F. Ridley, Elisabeth M. Hodson & Jonathan C. Craig (2009). "Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura". The Cochrane database of systematic reviews (1): CD003595. doi:10.1002/14651858.CD003595.pub2. PMID 19160220. Unknown parameter
|month=ignored (help)