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

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

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.

Kaynakça

  • 1. Schifferli A, von Vigier RO, Fontana M, et al. Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997-2003. Eur J Pediatr. 2010;169(5):591-598. doi:10.1007/s00431-009-1079-9
  • 2. Ardissino G, Tel F, Possenti I, et al. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Pediatrics. 2016;137(1). doi:10.1542/peds.2015-2153
  • 3. Fakhouri F, Zuber J, Frémeaux-Bacchi V, Loirat C. Haemolytic uraemic syndrome. Lancet Lond Engl. 2017;390(10095):681-696. doi:10.1016/S0140-6736(17)30062-4
  • 4. Walsh PR, Johnson S. Treatment and management of children with haemolytic uraemic syndrome. Arch Dis Child. 2018;103(3):285-291. doi:10.1136/archdischild-2016-311377
  • 5. Cody EM, Dixon BP. Hemolytic Uremic Syndrome. Pediatr Clin North Am. 2019;66(1):235-246. doi:10.1016/j.pcl.2018.09.011
  • 6. Keir LS. Shiga toxin associated hemolytic uremic syndrome. Hematol Oncol Clin North Am. 2015;29(3):525-539. doi:10.1016/j.hoc.2015.01.007
  • 7. Micheletti MV, Lavoratti G, Materassi M, Pela I. Hemolytic uremic syndrome: epidemiological and clinical features of a pediatric population in Tuscany. Kidney Blood Press Res. 2010;33(5):399-404. doi:10.1159/000320385
  • 8. Balgradean M, Croitoru A, Leibovitz E. An outbreak of hemolytic uremic syndrome in southern Romania during 2015-2016: Epidemiologic, clinical, laboratory, microbiologic, therapeutic and outcome characteristics. Pediatr Neonatol. 2019;60(1):87-94. doi:10.1016/j.pedneo.2018.04.011
  • 9. Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol Berl Ger. 2008;23(10):1749-1760. doi:10.1007/s00467-008-0935-6
  • 10. McCoy N, Weaver DJ. Hemolytic uremic syndrome with simultaneous Shiga toxin producing Escherichia coli and complement abnormalities. BMC Pediatr. 2014;14:278. doi:10.1186/1471-2431-14-278
  • 11. Falup-Pecurariu O, Lixandru RI, Cojocaru E, et al. Shiga toxin producing Escherichia coli-associated diarrhea and hemolytic uremic syndrome in young children in Romania. Gut Pathog. 2019;11:46. doi:10.1186/s13099-019-0327-4
  • 12. Bagga A, Khandelwal P, Mishra K, et al. Hemolytic uremic syndrome in a developing country: Consensus guidelines. Pediatr Nephrol Berl Ger. 2019;34(8):1465-1482. doi:10.1007/s00467-019-04233-7
  • 13. Garg AX, Suri RS, Barrowman N, et al. Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA. 2003;290(10):1360-1370. doi:10.1001/jama.290.10.1360
  • 14. Spinale JM, Ruebner RL, Copelovitch L, Kaplan BS. Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol Berl Ger. 2013;28(11):2097-2105. doi:10.1007/s00467-012-2383-6
  • 15. Flynn JT, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. Pediatrics. 2018;142(3). doi:10.1542/peds.2018-1739
  • 16. Schwartz GJ, Muñoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol JASN. 2009;20(3):629-637. doi:10.1681/ASN.2008030287
  • 17. Al-Eisa A, Al-Hajeri M. Hemolytic uremic syndrome in Kuwaiti Arab children. Pediatr Nephrol Berl Ger. 2001;16(12):1093-1098. doi:10.1007/s004670100036
  • 18. Ağbaş A, Göknar N, Akıncı N, et al. Outbreak of Shiga toxin-producing Escherichia-coli-associated hemolytic uremic syndrome in Istanbul in 2015: outcome and experience with eculizumab. Pediatr Nephrol Berl Ger. 2018;33(12):2371-2381. doi:10.1007/s00467-018-4033-0
  • 19. Kemper MJ. Outbreak of hemolytic uremic syndrome caused by E. coli O104:H4 in Germany: a pediatric perspective. Pediatr Nephrol Berl Ger. 2012;27(2):161-164. doi:10.1007/s00467-011-2067-7
  • 20. Alconcher LF, Coccia PA, Suarez ADC, et al. Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome. Pediatr Nephrol Berl Ger. 2018;33(10):1791-1798. doi:10.1007/s00467-018-3991-6
  • 21. Ekinci Z, Candan C, Alpay H, et al. Hemolytic uremic syndrome outbreak in Turkey in 2011. Turk J Pediatr. 2013;55(3):246-252.
  • 22. Freedman SB, Xie J, Neufeld MS, et al. Shiga Toxin-Producing Escherichia coli Infection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016;62(10):1251-1258. doi:10.1093/cid/ciw099
  • 23. Menne J, Nitschke M, Stingele R, et al. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. BMJ. 2012;345:e4565. doi:10.1136/bmj.e4565
  • 24. Nitschke M, Sayk F, Härtel C, et al. Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. JAMA. 2012;307(10):1046-1052. doi:10.1001/jama.2012.264
  • 25. Şahin S, Özdoğan EB, Kaya G, et al. Neurological Involvement in Pediatric Hemolytic Uremic Syndrome: A Symptom-Oriented Analysis. Neuropediatrics. 2017;48(5):363-370. doi:10.1055/s-0037-1603643
  • 26. Zhao S-A, Ning B-T, Mao J-H. Clinical characteristics of children with hemolytic uremic syndrome in Hangzhou, China. World J Pediatr WJP. 2017;13(2):183-185. doi:10.1007/s12519-017-0021-x
  • 27. Dotis J, Violaki A, Kotsiou M. Hemolytic uremic syndrome in a pediatric intensive care unit: a 5-year experience. Turk J Pediatr. 2011;53(2):237-240.
  • 28. Kielstein JT, Beutel G, Fleig S, et al. Best supportive care and therapeutic plasma exchange with or without eculizumab in Shiga-toxin-producing E. coli O104:H4 induced haemolytic-uraemic syndrome: an analysis of the German STEC-HUS registry. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2012;27(10):3807-3815. doi:10.1093/ndt/gfs394
  • 29. Fakhouri F, Loirat C. Anticomplement Treatment in Atypical and Typical Hemolytic Uremic Syndrome. Semin Hematol. 2018;55(3):150-158. doi:10.1053/j.seminhematol.2018.04.009
  • 30. Brady TM, Pruette C, Loeffler LF, et al. Typical Hus: Evidence of Acute Phase Complement Activation from a Daycare Outbreak. J Clin Exp Nephrol. 2016;1(2). doi:10.21767/2472-5056.100011
  • 31. Lapeyraque A-L, Malina M, Fremeaux-Bacchi V, et al. Eculizumab in severe Shiga-toxin-associated HUS. N Engl J Med. 2011;364(26):2561-2563. doi:10.1056/NEJMc1100859
  • 32. Pape L, Hartmann H, Bange FC, Suerbaum S, Bueltmann E, Ahlenstiel-Grunow T. Eculizumab in Typical Hemolytic Uremic Syndrome (HUS) With Neurological Involvement. Medicine (Baltimore). 2015;94(24):e1000. doi:10.1097/MD.0000000000001000
  • 33. Caillaud C, Zaloszyc A, Licht C, Pichault V, Frémeaux-Bacchi V, Fischbach M. CFH gene mutation in a case of Shiga toxin-associated hemolytic uremic syndrome (STEC-HUS). Pediatr Nephrol Berl Ger. 2016;31(1):157-161. doi:10.1007/s00467-015-3207-2

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

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

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.

Kaynakça

  • 1. Schifferli A, von Vigier RO, Fontana M, et al. Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997-2003. Eur J Pediatr. 2010;169(5):591-598. doi:10.1007/s00431-009-1079-9
  • 2. Ardissino G, Tel F, Possenti I, et al. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Pediatrics. 2016;137(1). doi:10.1542/peds.2015-2153
  • 3. Fakhouri F, Zuber J, Frémeaux-Bacchi V, Loirat C. Haemolytic uraemic syndrome. Lancet Lond Engl. 2017;390(10095):681-696. doi:10.1016/S0140-6736(17)30062-4
  • 4. Walsh PR, Johnson S. Treatment and management of children with haemolytic uraemic syndrome. Arch Dis Child. 2018;103(3):285-291. doi:10.1136/archdischild-2016-311377
  • 5. Cody EM, Dixon BP. Hemolytic Uremic Syndrome. Pediatr Clin North Am. 2019;66(1):235-246. doi:10.1016/j.pcl.2018.09.011
  • 6. Keir LS. Shiga toxin associated hemolytic uremic syndrome. Hematol Oncol Clin North Am. 2015;29(3):525-539. doi:10.1016/j.hoc.2015.01.007
  • 7. Micheletti MV, Lavoratti G, Materassi M, Pela I. Hemolytic uremic syndrome: epidemiological and clinical features of a pediatric population in Tuscany. Kidney Blood Press Res. 2010;33(5):399-404. doi:10.1159/000320385
  • 8. Balgradean M, Croitoru A, Leibovitz E. An outbreak of hemolytic uremic syndrome in southern Romania during 2015-2016: Epidemiologic, clinical, laboratory, microbiologic, therapeutic and outcome characteristics. Pediatr Neonatol. 2019;60(1):87-94. doi:10.1016/j.pedneo.2018.04.011
  • 9. Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol Berl Ger. 2008;23(10):1749-1760. doi:10.1007/s00467-008-0935-6
  • 10. McCoy N, Weaver DJ. Hemolytic uremic syndrome with simultaneous Shiga toxin producing Escherichia coli and complement abnormalities. BMC Pediatr. 2014;14:278. doi:10.1186/1471-2431-14-278
  • 11. Falup-Pecurariu O, Lixandru RI, Cojocaru E, et al. Shiga toxin producing Escherichia coli-associated diarrhea and hemolytic uremic syndrome in young children in Romania. Gut Pathog. 2019;11:46. doi:10.1186/s13099-019-0327-4
  • 12. Bagga A, Khandelwal P, Mishra K, et al. Hemolytic uremic syndrome in a developing country: Consensus guidelines. Pediatr Nephrol Berl Ger. 2019;34(8):1465-1482. doi:10.1007/s00467-019-04233-7
  • 13. Garg AX, Suri RS, Barrowman N, et al. Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA. 2003;290(10):1360-1370. doi:10.1001/jama.290.10.1360
  • 14. Spinale JM, Ruebner RL, Copelovitch L, Kaplan BS. Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol Berl Ger. 2013;28(11):2097-2105. doi:10.1007/s00467-012-2383-6
  • 15. Flynn JT, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. Pediatrics. 2018;142(3). doi:10.1542/peds.2018-1739
  • 16. Schwartz GJ, Muñoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol JASN. 2009;20(3):629-637. doi:10.1681/ASN.2008030287
  • 17. Al-Eisa A, Al-Hajeri M. Hemolytic uremic syndrome in Kuwaiti Arab children. Pediatr Nephrol Berl Ger. 2001;16(12):1093-1098. doi:10.1007/s004670100036
  • 18. Ağbaş A, Göknar N, Akıncı N, et al. Outbreak of Shiga toxin-producing Escherichia-coli-associated hemolytic uremic syndrome in Istanbul in 2015: outcome and experience with eculizumab. Pediatr Nephrol Berl Ger. 2018;33(12):2371-2381. doi:10.1007/s00467-018-4033-0
  • 19. Kemper MJ. Outbreak of hemolytic uremic syndrome caused by E. coli O104:H4 in Germany: a pediatric perspective. Pediatr Nephrol Berl Ger. 2012;27(2):161-164. doi:10.1007/s00467-011-2067-7
  • 20. Alconcher LF, Coccia PA, Suarez ADC, et al. Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome. Pediatr Nephrol Berl Ger. 2018;33(10):1791-1798. doi:10.1007/s00467-018-3991-6
  • 21. Ekinci Z, Candan C, Alpay H, et al. Hemolytic uremic syndrome outbreak in Turkey in 2011. Turk J Pediatr. 2013;55(3):246-252.
  • 22. Freedman SB, Xie J, Neufeld MS, et al. Shiga Toxin-Producing Escherichia coli Infection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016;62(10):1251-1258. doi:10.1093/cid/ciw099
  • 23. Menne J, Nitschke M, Stingele R, et al. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. BMJ. 2012;345:e4565. doi:10.1136/bmj.e4565
  • 24. Nitschke M, Sayk F, Härtel C, et al. Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. JAMA. 2012;307(10):1046-1052. doi:10.1001/jama.2012.264
  • 25. Şahin S, Özdoğan EB, Kaya G, et al. Neurological Involvement in Pediatric Hemolytic Uremic Syndrome: A Symptom-Oriented Analysis. Neuropediatrics. 2017;48(5):363-370. doi:10.1055/s-0037-1603643
  • 26. Zhao S-A, Ning B-T, Mao J-H. Clinical characteristics of children with hemolytic uremic syndrome in Hangzhou, China. World J Pediatr WJP. 2017;13(2):183-185. doi:10.1007/s12519-017-0021-x
  • 27. Dotis J, Violaki A, Kotsiou M. Hemolytic uremic syndrome in a pediatric intensive care unit: a 5-year experience. Turk J Pediatr. 2011;53(2):237-240.
  • 28. Kielstein JT, Beutel G, Fleig S, et al. Best supportive care and therapeutic plasma exchange with or without eculizumab in Shiga-toxin-producing E. coli O104:H4 induced haemolytic-uraemic syndrome: an analysis of the German STEC-HUS registry. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2012;27(10):3807-3815. doi:10.1093/ndt/gfs394
  • 29. Fakhouri F, Loirat C. Anticomplement Treatment in Atypical and Typical Hemolytic Uremic Syndrome. Semin Hematol. 2018;55(3):150-158. doi:10.1053/j.seminhematol.2018.04.009
  • 30. Brady TM, Pruette C, Loeffler LF, et al. Typical Hus: Evidence of Acute Phase Complement Activation from a Daycare Outbreak. J Clin Exp Nephrol. 2016;1(2). doi:10.21767/2472-5056.100011
  • 31. Lapeyraque A-L, Malina M, Fremeaux-Bacchi V, et al. Eculizumab in severe Shiga-toxin-associated HUS. N Engl J Med. 2011;364(26):2561-2563. doi:10.1056/NEJMc1100859
  • 32. Pape L, Hartmann H, Bange FC, Suerbaum S, Bueltmann E, Ahlenstiel-Grunow T. Eculizumab in Typical Hemolytic Uremic Syndrome (HUS) With Neurological Involvement. Medicine (Baltimore). 2015;94(24):e1000. doi:10.1097/MD.0000000000001000
  • 33. Caillaud C, Zaloszyc A, Licht C, Pichault V, Frémeaux-Bacchi V, Fischbach M. CFH gene mutation in a case of Shiga toxin-associated hemolytic uremic syndrome (STEC-HUS). Pediatr Nephrol Berl Ger. 2016;31(1):157-161. doi:10.1007/s00467-015-3207-2

Ayrıntılar

Birincil Dil Türkçe
Konular Pediatri
Bölüm Araştırma Makaleleri
Yazarlar

Caner ALPARSLAN (Sorumlu Yazar)
İZMİR TEPECİK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0002-7046-8907
Türkiye


Mehmet Nur TALAY
DİYARBAKIR GAZİ YAŞARGİL SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0002-7361-3823
Türkiye


Aysel TAKTAK
HATAY MUSTAFA KEMAL ÜNİVERSİTESİ
0000-0001-7724-9160
Türkiye


Murat KANĞIN Bu kişi benim
DİYARBAKIR GAZİ YAŞARGİL SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0003-0042-0569
Türkiye

Yayımlanma Tarihi 17 Mayıs 2021
Yayınlandığı Sayı Yıl 2021, Cilt 21, Sayı 1

Kaynak Göster

Bibtex @araştırma makalesi { jchild860634, journal = {Çocuk Dergisi}, issn = {}, eissn = {1308-8491}, address = {Çocuk Dergisi Yayın Kurulu Sekreterliği İstanbul Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çapa, 34390, İstanbul}, publisher = {İstanbul Üniversitesi}, year = {2021}, volume = {21}, pages = {13 - 20}, doi = {}, title = {Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi}, key = {cite}, author = {Alparslan, Caner and Talay, Mehmet Nur and Taktak, Aysel and Kanğın, Murat} }
APA Alparslan, C. , Talay, M. N. , Taktak, A. & Kanğın, M. (2021). Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi . Çocuk Dergisi , 21 (1) , 13-20 . Retrieved from https://dergipark.org.tr/tr/pub/jchild/issue/60453/860634
MLA Alparslan, C. , Talay, M. N. , Taktak, A. , Kanğın, M. "Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi" . Çocuk Dergisi 21 (2021 ): 13-20 <https://dergipark.org.tr/tr/pub/jchild/issue/60453/860634>
Chicago Alparslan, C. , Talay, M. N. , Taktak, A. , Kanğın, M. "Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi". Çocuk Dergisi 21 (2021 ): 13-20
RIS TY - JOUR T1 - Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi AU - Caner Alparslan , Mehmet Nur Talay , Aysel Taktak , Murat Kanğın Y1 - 2021 PY - 2021 N1 - DO - T2 - Çocuk Dergisi JF - Journal JO - JOR SP - 13 EP - 20 VL - 21 IS - 1 SN - -1308-8491 M3 - UR - Y2 - 2021 ER -
EndNote %0 Çocuk Dergisi Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi %A Caner Alparslan , Mehmet Nur Talay , Aysel Taktak , Murat Kanğın %T Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi %D 2021 %J Çocuk Dergisi %P -1308-8491 %V 21 %N 1 %R %U
ISNAD Alparslan, Caner , Talay, Mehmet Nur , Taktak, Aysel , Kanğın, Murat . "Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi". Çocuk Dergisi 21 / 1 (Mayıs 2021): 13-20 .
AMA Alparslan C. , Talay M. N. , Taktak A. , Kanğın M. Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi. Çocuk Dergisi. 2021; 21(1): 13-20.
Vancouver Alparslan C. , Talay M. N. , Taktak A. , Kanğın M. Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi. Çocuk Dergisi. 2021; 21(1): 13-20.
IEEE C. Alparslan , M. N. Talay , A. Taktak ve M. Kanğın , "Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi", Çocuk Dergisi, c. 21, sayı. 1, ss. 13-20, May. 2021