Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi

Yıl 2021, Cilt: 21 Sayı: 1, 13 - 20, 17.05.2021

Caner Alparslan , Mehmet Nur Talay , Aysel Taktak , Murat Kanğın

Öz

Amaç: Hemolitik üremik sendrom, akut böbrek hasarı, hemolitik anemi ve trombositopeni ile karakterizedir. Çocuklarda en sık diyare ilişkili HÜS (D+ HÜS) olarak görülmektedir. Bu çalışmada amaç D+HÜS klinik parametrelerinin ve hastalığın sonlanımı açısından öngördürücülerin belirlenmesidir. Gereç ve Yöntem: Geriye dönük olarak yapılan bu çalışmaya Mart 2019 – Ağustos 2020 tarihleri arasında çocuk yoğun bakımda D+HÜS tanısı alan 15 hasta dahil edildi. Olguların demografik özellikleri, başvuru yaşamsal bulguları, laboratuvar parametreleri (hemoglobin, hemotokrit, beyaz kan hücresi, trombosit, kreatinin, üre, ürik asit, laktat dehidrogenaz, aspartat aminotransferaz, alanin aminotransferaz, amilaz, albümin, C3 ve C4), plazma tedavisi, plazma değişimi, böbrek yerine koyma tedavisi (BYKT) uygulandıysa tipi ve süresi, kan ürünü ihtiyacı olup olmadığı incelendi. Ayrıca olgularda böbrek dışında organ tutulumu varlığı, eculizumab tedavisi kullanımı ve izlemde son durumları kayıt altına alındı. Bulgular: Çalışma grubunun 9’u (%60) erkek olup, yaş ortalaması ortanca 18 ay olarak hesaplandı. Tüm çalışma grubunun %60’ında BYKT ihtiyacı olup, periton diyalizinin [5 (%33,3)] en sık tercih edilen yöntem olduğu görüldü. Beş olguda (%33,3) böbrek dışı organ tutulumu izlendi. Taburculuk sonrası izlem süresince (ort:9,59±6,03 ay), 9 (%60)’unun normale döndüğü, 3 (%20)’ünün proteinüri, 1 (%6,6)’inde kronik böbrek hastalığı, 1 (%6,6)’inde son dönem böbrek yetmezliği ve 1 (%6,6)’inde de nörolojik sekel kaldığı görüldü. Hastane yatış ve oligoanüri süresinin sekel gelişimi üzerine istatistiksel olarak anlamlı etkisi olduğu görüldü [Hastane yatış süre: OR:1,28 (%95 CI:0,77–0,98) (p=0,04), Oligoanüri süre: OR:1,46 (%95 CI:0,94–1) (p=0,04)]. Sonuç: Bu çalışmada hastane yatış ve oligoanüri süresinin sekel gelişimi üzerine anlamlı etkisi gösterildi. Bu hastalığın daha iyi tanınarak yönetiminin geliştirilmesi ile bu kötü sonuçların azaltılabilmesi için daha çok klinik çalışmaya ihtiyaç olduğunu düşünmekteyiz.

Anahtar Kelimeler

çocuk, hemolitik üremik sendrom, diyare, yoğun bakım

Single Center Experience of Diarrhea Associated Hemolytic Uremic Syndrome in Pediatric Intensive Care Unit

Öz

Objective: Hemolytic uremic syndrome (HUS) is characterised by acute kidney injury, hemolytic anemia and thrombocytopenia. In children, it is mostly related with diarrhea (D+). In this paper, we aimed to determine clinical parameters and prognostic factors in D+HUS. Materials and Methods: This retrospective study was conducted with D+HUS 15 pediatric patients in a pediatric intensive care unit between March 2019 and August 2020. Patients demographics, initial vital signs, laboratory parameters (hemoglobine, hematocrit, white blood cell, platellets, creatinine, urea, uric acid, lactat dehydrogenase, aspartat aminotransferase, alanine aminotransferase, amilase, albumine, C3 and C4), plasma therapy, plasma exchange, RRT type and duration, and the need for blood products were evaluated. Therefore, extra-renal involvement, eculizumab treatment and last follow-up were recorded. Results: The study group consisted of 9 males (60%) and the median age was calculated as 18 months. In 60% of the patients, RRT was implemented. Peritoneal dialysis (in 5) was the most preferded dialysis method. Five patients (33%) had extra-renal involvement. Nine patients (60%) had completely recovered, therefore proteinuria, chronic kidney disease, endstage kidney disease and neurologic sequel developed in 3 (20%), 1 (6.6%), 1 (6.6%) and 1 (6.6%), respectively. Hospitalization and oligoanuria duration had a significant impact on sequel development [Hospitalization duration: OR:1.28 (%95 CI:0.77–0.98) (p=0.04), Oligoanuria duration: OR:1.46 (%95 CI:0.94–1) (p=0.04)]. Conclusion: In this study, we showed that hospitalization and oligoanuria duration had a significant impact on sequel development. We believe that there is a need for more clinical studies to delinate more precise mechanisms of the disease and eliminate worse outcomes of D+HUS.

Anahtar Kelimeler

child, hemolytic uremic syndrome, diarrhea, intensive care unit

Kaynakça

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