Guidelines on Hemolytic Uremic Syndrome by Indian Society of Pediatric Nephrology: Key Messages
- PDF / 493,334 Bytes
- 4 Pages / 612 x 792 pts (letter) Page_size
- 93 Downloads / 227 Views
Guidelines on Hemolytic Uremic Syndrome by Indian Society of Pediatric Nephrology: Key Messages PRIYANKA KHANDELWAL AND ARVIND BAGGA From the Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Arvind Bagga, Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. [email protected] Hemolytic uremic syndrome is an important cause of acute kidney injury that requires dialysis in children. The diagnosis and management is difficult due to limited diagnostic facilities and non-availability of specific complement inhibitors. We describe salient features of the recent Indian Society of Pediatric Nephrology consensus guidelines on hemolytic uremic syndrome. Keywords: Factor H antibodies, Plasma exchange, Thrombotic microangiopathy.
H
Rule-out Infections
emolytic uremic syndrome (HUS) is an important cause of acute kidney injury (AKI) requiring renal replacement therapy. Rapid diagnosis and management is necessary to limit irreversible renal damage. Although Shiga toxinassociated HUS constitutes the chief form of the disease worldwide, burden of this illness in India is not clear. School-going children show high prevalence of antifactor H (FH) antibody-associated HUS. While International guidelines emphasize comprehensive diagnostic evaluation and complement blockade with eculizumab, access to these facilities is limited in India. Given the difference in epidemiology and challenges in management, guidelines for treatment of HUS were recently published by the Indian Society of Pediatric Nephrology (ISPN) [1]. This article highlights key messages from these guidelines.
Disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP) should be ruled out in patients with suspected HUS. Infections that mimic/trigger HUS, e.g., malaria, leptospirosis, dengue, rickettsia and H1N1 infection should be excluded, if clinically suspected. DIC is characterized by prolonged prothrombin time or activated partial thromboplastin time, low fibrinogen, elevated D-dimer and soluble fibrin monomers. TTP is rare in childhood; persistent thrombocytopenia (100,000/ μL, schistocytes
Data Loading...
