Adult haemolytic and uraemic syndrome: causes and prognostic factors in the last decade
Tostivint I, Mougenot B, Flahault A, Vigneau C, Costa M, Haymann J, Sraer J, Rondeau E. Nephrology Dialysis Transplantation 2002;17:1228-1234.
Hemolytic uremic syndrome (HUS) is a rare disease in adults, accounting for less than 5% of the causes of acute renal failure. Compared with the typical pediatric form, HUS in adults is more diverse and may complicate several underlying diseases. This was evident in a French study of 55 adults in a renal intensive care unit between 1990 and 1998, in which risk factors for in-hospital mortality and renal function at discharge were studied. HUS complicated different diseases, including HIV infection, renal problems, renal, liver, and bone marrow transplants, and malignant diseases; 15 patients had primary HUS. Verotoxin (associated with E. coli infections) was detected in only three cases. Fresh frozen plasma infusion (FFP) was given in most cases, in addition to other standard therapies. Positive HIV serology and required hemodialysis increased the odds of in-hospital mortality. A preexisting kidney condition was a poor prognostic factor for renal function, while fever was associated with a better renal prognosis. Improved renal outcomes in those with primary HUS, in particular, suggested a beneficial effect of FFP.