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Haemolytic-uraemic syndrome: survival after prolonged oliguria.

1968; BMJ; Volume: 43; Issue: 232 Linguagem: Inglês

10.1136/adc.43.232.711

1468-2044

P Sharpstone, Roger G. Evans, Margaret O’Shea, Laura M. Alexander, H. A. Lee,

Erythrocyte Function and Pathophysiology

Since the original definition of the haemolyticuraemic syndrome by Gasser et al. (1955), there have been many reports of infants and children suffering from this distinctive combination of haematological and renal disorders.The clinical features usually include diarrhoea and vomiting of acute onset, succeeded by pallor and sometimes bruising or petechiae.Oliguria is common but its duration is variable and hypertension occurs in some cases.The blood picture shows a 'micro- angiopathic haemolytic anaemia' (Brain, Dacie, and Hourihane, 1962), with bizarre, distorted, and fragmented red blood cells, burr cells, poikilo- cytosis, anisocytosis, spherocytosis, and polychromasia.The direct Coombs test is negative, the reticulocyte count is raised, and thrombocytopenia of variable degree is often present.Haemoglobinaemia and haemoglobinuria occur in the more severe cases.The urine contains protein and red blood cells, and the blood urea is raised in proportion to the degree of oliguria.Compre- hensive reviews include those of Lieberman et al. (1966), Piel and Phibbs (1966), and Habib, Mathieu, and Royer (1967).The mortality of 150 reported cases was 43% (McLean, Jones, and Sutherland, 1966), death resulting usually from uraemia or its complications.Prolonged anuria or oliguria in this disease is considered of sinister significance, and we, therefore, report here 3 patients with the haemolytic-uraemic syndrome who recovered, with the aid of dialysis, after periods of oliguria of 23, 24, and 15 days duration, respectively.Case Reports Case 1.This female infant, born prematurely at 32 weeks (birthweight 1 * 36 kg.), progressed satisfactorily until June 30,1963,when at the age of 23weeks she devel- oped diarrhoea and vomiting.The following day she had