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complements&#44; anti-neutrophil cytoplasmic antibodies&#44; anti-nuclear antibodies and anti-glomerular basement membrane antibodies&#44; which was negative&#44; thus ruling out systemic disease&#46;</p><p class="elsevierStylePara">This data resulted in the diagnosis of HUS and support measures began with fluid therapy and plasmapheresis sessions through the temporary right femoral catheter&#44; which was added to prednisone therapy &#40;1mg&#47;kg&#47;weight&#41;&#46;</p><p class="elsevierStylePara">During the first seven days&#44; evolution was slow&#44; there was no response to daily plasmapheresis sessions and symptoms increased&#44; beginning with an abrupt drop in the platelet count &#40;19&#160;000&#47;mm<span class="elsevierStyleSup">3</span>&#41; and acute renal failure with anuria &#40;renal function&#58; creatinine 6 mg&#47;dl&#41;&#46; Three haemodialysis sessions were necessary&#46;</p><p class="elsevierStylePara">In the eleventh session of daily plasmapheresis&#44; there is a progressive increase in the number of platelets &#40;86&#160;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; an improvement in renal function &#40;creatinine 1&#46;5mg&#47;dl&#41; and increased diuresis &#40;3000cc&#47;24h&#41;&#44; the haemodialysis sessions were therefore suspended&#46;</p><p class="elsevierStylePara">Given the great clinical and laboratory test improvement&#44; it was decided to continue with plasmapheresis sessions on alternate days with a progressive improvement both in renal function &#40;until it normalised &#91;creatinine 1&#46;1mg&#47;dl&#93;&#41; and haemolytic anaemia &#40;haemoglobin&#58; 9&#46;6g&#47;dl&#41; and an increase in the platelet count &#40;platelets&#58; 115&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#59; diuresis was 2500cc&#47;24h&#46; The evolution of the patient is summarised in Figure 1&#46;</p><p class="elsevierStylePara">The patient is currently clinically asymptomatic and normotensive with laboratory parameters &#40;renal function&#44; haemoglobin and platelets&#41; being normal&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The HUS is a constellation of signs and symptoms characterised by the triad of microangiopathic haemolytic anaemia&#44; thrombocytopaenia and acute renal failure&#46;</p><p class="elsevierStylePara">This disorder may be divided into two forms in accordance with the association or non-association with bacteria that produce the Shiga-like toxin&#44; as well as the clinical presentation&#58;</p><p class="elsevierStylePara">- Typical HUS or HUS associated with the Shiga toxin &#40;Stx&#41; is the most common form of HUS &#40;occurring in 90&#37; of cases&#41;&#46; It is caused by infection transmitted by food containing Shiga Toxigenic Escherichia coli&#46; It usually occurs after an often bloody prodromal diarrhoea episode&#46; It is usually self-limiting and normally has a benign course&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">- Atypical HUS or HUS not associated with Shiga toxin accounts for 10&#37; of cases of HUS&#46; The disease may occur sporadically &#40;&#60;20&#37; of cases&#41; or run in families&#46; It is a heterogeneous group of disorders characterised clinically by the absence of diarrhoea in 92&#37; of cases and a worse prognosis&#46; Most patients have recurrences and over 50&#37; develop stage 5 chronic kidney disease&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The diagnosis to establish the association between HUS and infection by Shiga Toxigenic Escherichia coli &#40;STEC&#41; is based on three criteria&#58; isolation and characterisation of the pathogen&#44; detection of free faecal Stx and anti-Stx antibodies in serum&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">One of the limiting factors in applying all new and specific treatments is that the timeframe between diagnosis infection due to STEC and the applicability of the latter is very narrow&#46; The diagnosis of the infection due to STEC should be carried out within 48 h of the time when diarrhoea began&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In our case&#44; it was not possible to confirm diagnosis&#44; since the patient came in six days after the symptoms began&#59; however&#44; given that the symptoms suggested infection by <span class="elsevierStyleItalic">E&#46; coli</span> &#40;abdominal pain and bloody diarrhoeal stools&#41; along with thrombocytopenia&#44; microangiopathic haemolytic anaemia &#40;high LDH and decreased haemoglobin&#41; and the onset of acute renal failure&#44; as well as good patient evolution&#44; we confirmed that this was a case of typical HUS&#46;</p><p class="elsevierStylePara">When HUS is suspected&#44; it is essential to start treatment immediately&#44; since it usually progresses and causes irreversible renal failure&#44; progressive neurological deterioration&#44; cardiac ischaemia and even death&#46;</p><p class="elsevierStylePara">In conclusion&#44; we insist that the best way to reduce cases of HUS is prevention&#58; more stringent controls at all points of the food chain that ensure compliance with all food science laws and regulations at all levels&#44; along with educational policies for the population as a whole&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11735&#95;16025&#95;46843&#95;en&#95;t111735&#46;jpg" class="elsevierStyleCrossRefs"><img src="11735_16025_46843_en_t111735.jpg" alt="Graph displaying evolution"></img></a></p><p class="elsevierStylePara">Figure 1&#46; 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Plasmapheresis in the treatment of typical haemolytic-uraemic syndrome
Plasmaféresis en el tratamiento del síndrome hemolítico-urémico típico
M. Inmaculada Poveda-Garcíaa, M. Carmen Prados-Solera, M. Dolores Del Pino-y-Pinoa, Remedios Garófano-Lópeza, Mercedes Alfaro-Tejedaa, Francisco J. Guerrero-Camachoa, Beatriz García-Maldonadoa, David Sánchez-Martosa, Felisa Sánchez-Martíneza
a Unidad de Gestión Clínica de Nefrología, Hospital Torrecárdenas, Almería,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Content</span></p><p class="elsevierStylePara">Haemolytic-uraemic syndrome &#40;HUS&#41; is a disorder of the microvasculature&#44; clinically defined by microangiopathic haemolytic anaemia &#40;negative direct Coombs test&#41; and thrombocytopaenia&#44; that mainly affects the kidneys and is manifested by haematuria&#44; oliguria and renal failure&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL CASE</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A 14 year-old female with no relevant history&#46; After returning from a trip to Istanbul&#44; she began suffering episodes of diarrheal stools of a mucosanguineous nature &#40;14-15 stools&#47;day&#41;&#44; accompanied by vomiting&#44; abdominal pain&#44; generalised weakness and fever&#46; After these symptoms persisted for five days&#44; she started suffering haematuria and oliguria and came to our hospital where deterioration of the glomerular filtration rate was detected in the laboratory &#40;creatinine&#58; 1&#46;62mg&#47;dl&#41;&#44; thrombocytopenia &#40;84&#160;000mm<span class="elsevierStyleSup">3</span>&#41; and haemolytic anaemia accompanied by hyperbilirubinaemia at the expense of direct bilirubin &#40;DB&#41; &#40;haemoglobin&#58; 10&#46;6g&#47;dl&#44; DB&#58; 2&#46;3mg&#47;dl&#41;&#59; coagulation tests were normal&#46; When HUS was suspected&#44; a new laboratory test was performed using a blood smear&#59; severe deterioration was noted both clinically and in the laboratory&#58; creatinine 2&#46;6mg&#47;dl&#44; platelets&#58; 39&#160;000mm&#44;<span class="elsevierStyleSup">3</span> haemoglobin 7g&#47;dl &#40;transfusion of 2 units of packed red blood cells was required&#41;&#46; The presence of schistocytes in the blood smear was notable&#44; and the stool test was negative for Shiga toxin&#46;</p><p class="elsevierStylePara">An immunological study was performed with immunoglobulins&#44; complements&#44; anti-neutrophil cytoplasmic antibodies&#44; anti-nuclear antibodies and anti-glomerular basement membrane antibodies&#44; which was negative&#44; thus ruling out systemic disease&#46;</p><p class="elsevierStylePara">This data resulted in the diagnosis of HUS and support measures began with fluid therapy and plasmapheresis sessions through the temporary right femoral catheter&#44; which was added to prednisone therapy &#40;1mg&#47;kg&#47;weight&#41;&#46;</p><p class="elsevierStylePara">During the first seven days&#44; evolution was slow&#44; there was no response to daily plasmapheresis sessions and symptoms increased&#44; beginning with an abrupt drop in the platelet count &#40;19&#160;000&#47;mm<span class="elsevierStyleSup">3</span>&#41; and acute renal failure with anuria &#40;renal function&#58; creatinine 6 mg&#47;dl&#41;&#46; Three haemodialysis sessions were necessary&#46;</p><p class="elsevierStylePara">In the eleventh session of daily plasmapheresis&#44; there is a progressive increase in the number of platelets &#40;86&#160;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; an improvement in renal function &#40;creatinine 1&#46;5mg&#47;dl&#41; and increased diuresis &#40;3000cc&#47;24h&#41;&#44; the haemodialysis sessions were therefore suspended&#46;</p><p class="elsevierStylePara">Given the great clinical and laboratory test improvement&#44; it was decided to continue with plasmapheresis sessions on alternate days with a progressive improvement both in renal function &#40;until it normalised &#91;creatinine 1&#46;1mg&#47;dl&#93;&#41; and haemolytic anaemia &#40;haemoglobin&#58; 9&#46;6g&#47;dl&#41; and an increase in the platelet count &#40;platelets&#58; 115&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#59; diuresis was 2500cc&#47;24h&#46; The evolution of the patient is summarised in Figure 1&#46;</p><p class="elsevierStylePara">The patient is currently clinically asymptomatic and normotensive with laboratory parameters &#40;renal function&#44; haemoglobin and platelets&#41; being normal&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The HUS is a constellation of signs and symptoms characterised by the triad of microangiopathic haemolytic anaemia&#44; thrombocytopaenia and acute renal failure&#46;</p><p class="elsevierStylePara">This disorder may be divided into two forms in accordance with the association or non-association with bacteria that produce the Shiga-like toxin&#44; as well as the clinical presentation&#58;</p><p class="elsevierStylePara">- Typical HUS or HUS associated with the Shiga toxin &#40;Stx&#41; is the most common form of HUS &#40;occurring in 90&#37; of cases&#41;&#46; It is caused by infection transmitted by food containing Shiga Toxigenic Escherichia coli&#46; It usually occurs after an often bloody prodromal diarrhoea episode&#46; It is usually self-limiting and normally has a benign course&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">- Atypical HUS or HUS not associated with Shiga toxin accounts for 10&#37; of cases of HUS&#46; The disease may occur sporadically &#40;&#60;20&#37; of cases&#41; or run in families&#46; It is a heterogeneous group of disorders characterised clinically by the absence of diarrhoea in 92&#37; of cases and a worse prognosis&#46; Most patients have recurrences and over 50&#37; develop stage 5 chronic kidney disease&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The diagnosis to establish the association between HUS and infection by Shiga Toxigenic Escherichia coli &#40;STEC&#41; is based on three criteria&#58; isolation and characterisation of the pathogen&#44; detection of free faecal Stx and anti-Stx antibodies in serum&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">One of the limiting factors in applying all new and specific treatments is that the timeframe between diagnosis infection due to STEC and the applicability of the latter is very narrow&#46; The diagnosis of the infection due to STEC should be carried out within 48 h of the time when diarrhoea began&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In our case&#44; it was not possible to confirm diagnosis&#44; since the patient came in six days after the symptoms began&#59; however&#44; given that the symptoms suggested infection by <span class="elsevierStyleItalic">E&#46; coli</span> &#40;abdominal pain and bloody diarrhoeal stools&#41; along with thrombocytopenia&#44; microangiopathic haemolytic anaemia &#40;high LDH and decreased haemoglobin&#41; and the onset of acute renal failure&#44; as well as good patient evolution&#44; we confirmed that this was a case of typical HUS&#46;</p><p class="elsevierStylePara">When HUS is suspected&#44; it is essential to start treatment immediately&#44; since it usually progresses and causes irreversible renal failure&#44; progressive neurological deterioration&#44; cardiac ischaemia and even death&#46;</p><p class="elsevierStylePara">In conclusion&#44; we insist that the best way to reduce cases of HUS is prevention&#58; more stringent controls at all points of the food chain that ensure compliance with all food science laws and regulations at all levels&#44; along with educational policies for the population as a whole&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11735&#95;16025&#95;46843&#95;en&#95;t111735&#46;jpg" class="elsevierStyleCrossRefs"><img src="11735_16025_46843_en_t111735.jpg" alt="Graph displaying evolution"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Graph displaying evolution</p>"
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Article information
ISSN: 20132514
Original language: English
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2020 December 111 14 125
2020 November 83 22 105
2020 October 78 12 90
2020 September 67 20 87
2020 August 74 10 84
2020 July 102 7 109
2020 June 91 19 110
2020 May 70 10 80
2020 April 70 17 87
2020 March 95 14 109
2020 February 94 17 111
2020 January 113 30 143
2019 December 108 35 143
2019 November 79 16 95
2019 October 63 5 68
2019 September 100 26 126
2019 August 60 10 70
2019 July 78 25 103
2019 June 53 12 65
2019 May 66 11 77
2019 April 136 43 179
2019 March 65 17 82
2019 February 52 17 69
2019 January 65 17 82
2018 December 101 34 135
2018 November 111 19 130
2018 October 125 23 148
2018 September 87 16 103
2018 August 88 17 105
2018 July 85 10 95
2018 June 73 13 86
2018 May 114 16 130
2018 April 131 8 139
2018 March 99 11 110
2018 February 60 6 66
2018 January 79 8 87
2017 December 101 10 111
2017 November 68 11 79
2017 October 61 9 70
2017 September 59 11 70
2017 August 67 9 76
2017 July 69 8 77
2017 June 58 7 65
2017 May 51 8 59
2017 April 57 4 61
2017 March 40 2 42
2017 February 36 9 45
2017 January 36 11 47
2016 December 80 5 85
2016 November 99 9 108
2016 October 120 7 127
2016 September 124 4 128
2016 August 237 6 243
2016 July 209 5 214
2016 June 144 0 144
2016 May 132 0 132
2016 April 91 0 91
2016 March 90 0 90
2016 February 106 0 106
2016 January 128 0 128
2015 December 137 0 137
2015 November 94 0 94
2015 October 111 0 111
2015 September 76 0 76
2015 August 78 0 78
2015 July 81 0 81
2015 June 46 0 46
2015 May 55 0 55
2015 April 8 0 8
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Idiomas
Nefrología (English Edition)