A pediatric case with hemolytic uremic syndrome associated with COVID-19, which progressed to end-stage kidney disease

Serra Sürmeli Döven, Esra Danacı Vatansever, Yasemin Yuyucu Karabulut, Berfin Özgökçe Özmen, Fatma Durak, Ali Delibaş
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Abstract

Background. Hemolytic uremic syndrome (HUS) is a serious cause of acute kidney injury in children. There is a suggestion that coronavirus disease 2019 (COVID-19) may be a trigger for HUS. In this study, we present a pediatric case diagnosed with HUS associated with COVID-19, which progressed to end-stage kidney disease. Case. A previously healthy 13-year-old girl with fever and vomiting was referred to our hospital. Laboratory investigations revealed direct Coombs-negative hemolytic anemia, thrombocytopenia and renal impairment accompanied by COVID-19 infection. Although anemia and thrombocytopenia showed improvement on the seventh day after admission, the renal impairment persisted. The histopathological findings of a renal biopsy were compatible with both HUS and COVID-19. One month later, the patient had a recurrence of HUS, again testing positive for COVID-19. Kidney function improved with plasma exchange therapy. Eculizumab treatment was recommenced after COVID-19 PCR became negative. Anemia and thrombocytopenia did not recur with eculizumab, while renal impairment persisted. Eculizumab was discontinued after three months when genetic analysis for HUS was negative. Subsequently, the patient was diagnosed with end-stage kidney disease. Conclusions. COVID-19 can be associated with HUS relapses, leading to chronic kidney disease. Further studies should investigate the mechanism of HUS associated with COVID-19.
一例与 COVID-19 相关的溶血性尿毒症并发展为终末期肾病的儿科病例
背景。溶血性尿毒症(HUS)是导致儿童急性肾损伤的一个严重原因。有一种观点认为,冠状病毒病 2019(COVID-19)可能是 HUS 的诱因。在本研究中,我们介绍了一例被诊断为与COVID-19相关的HUS,并发展为终末期肾病的儿科病例。一名原本健康的13岁女孩因发热和呕吐被转诊至我院。实验室检查显示,Coombs 直接阴性溶血性贫血、血小板减少和肾功能损害伴有 COVID-19 感染。虽然贫血和血小板减少在入院后第七天有所改善,但肾功能损害仍持续存在。肾活检的组织病理学结果与 HUS 和 COVID-19 都相符。一个月后,患者的 HUS 复发,COVID-19 检测再次呈阳性。经血浆置换治疗后,肾功能有所改善。COVID-19 PCR检测呈阴性后,重新开始使用依库珠单抗治疗。使用依库珠单抗后,贫血和血小板减少症没有复发,但肾功能损害持续存在。三个月后,当 HUS 基因分析呈阴性时,停用了依库珠单抗。随后,患者被诊断为终末期肾病。结论:COVID-19与HUS复发有关,可导致慢性肾病。结论:COVID-19可能与HUS复发有关,并导致慢性肾脏疾病,应进一步研究COVID-19导致HUS的机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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