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"apellidos" => "Guerrero-Camacho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "nombre" => "Beatriz" "apellidos" => "García-Maldonado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 7 => array:3 [ "nombre" => "David" "apellidos" => "Sánchez-Martos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 8 => array:3 [ "nombre" => "Felisa" "apellidos" => "Sánchez-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Nefrología, Hospital Torrecárdenas, Almería, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Plasmaféresis en el tratamiento del síndrome hemolítico-urémico típico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11735_16025_46843_en_t111735.jpg" "Alto" => 1406 "Ancho" => 1376 "Tamanyo" => 320754 ] ] "descripcion" => array:1 [ "en" => "Graph displaying evolution" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Content</span></p><p class="elsevierStylePara">Haemolytic-uraemic syndrome (HUS) is a disorder of the microvasculature, clinically defined by microangiopathic haemolytic anaemia (negative direct Coombs test) and thrombocytopaenia, that mainly affects the kidneys and is manifested by haematuria, oliguria and renal failure.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL CASE</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">A 14 year-old female with no relevant history. After returning from a trip to Istanbul, she began suffering episodes of diarrheal stools of a mucosanguineous nature (14-15 stools/day), accompanied by vomiting, abdominal pain, generalised weakness and fever. After these symptoms persisted for five days, she started suffering haematuria and oliguria and came to our hospital where deterioration of the glomerular filtration rate was detected in the laboratory (creatinine: 1.62mg/dl), thrombocytopenia (84 000mm<span class="elsevierStyleSup">3</span>) and haemolytic anaemia accompanied by hyperbilirubinaemia at the expense of direct bilirubin (DB) (haemoglobin: 10.6g/dl, DB: 2.3mg/dl); coagulation tests were normal. When HUS was suspected, a new laboratory test was performed using a blood smear; severe deterioration was noted both clinically and in the laboratory: creatinine 2.6mg/dl, platelets: 39 000mm,<span class="elsevierStyleSup">3</span> haemoglobin 7g/dl (transfusion of 2 units of packed red blood cells was required). The presence of schistocytes in the blood smear was notable, and the stool test was negative for Shiga toxin.</p><p class="elsevierStylePara">An immunological study was performed with immunoglobulins, complements, anti-neutrophil cytoplasmic antibodies, anti-nuclear antibodies and anti-glomerular basement membrane antibodies, which was negative, thus ruling out systemic disease.</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, which was added to prednisone therapy (1mg/kg/weight).</p><p class="elsevierStylePara">During the first seven days, evolution was slow, there was no response to daily plasmapheresis sessions and symptoms increased, beginning with an abrupt drop in the platelet count (19 000/mm<span class="elsevierStyleSup">3</span>) and acute renal failure with anuria (renal function: creatinine 6 mg/dl). Three haemodialysis sessions were necessary.</p><p class="elsevierStylePara">In the eleventh session of daily plasmapheresis, there is a progressive increase in the number of platelets (86 000/mm<span class="elsevierStyleSup">3</span>), an improvement in renal function (creatinine 1.5mg/dl) and increased diuresis (3000cc/24h), the haemodialysis sessions were therefore suspended.</p><p class="elsevierStylePara">Given the great clinical and laboratory test improvement, it was decided to continue with plasmapheresis sessions on alternate days with a progressive improvement both in renal function (until it normalised [creatinine 1.1mg/dl]) and haemolytic anaemia (haemoglobin: 9.6g/dl) and an increase in the platelet count (platelets: 115,000/mm<span class="elsevierStyleSup">3</span>); diuresis was 2500cc/24h. The evolution of the patient is summarised in Figure 1.</p><p class="elsevierStylePara">The patient is currently clinically asymptomatic and normotensive with laboratory parameters (renal function, haemoglobin and platelets) being normal.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The HUS is a constellation of signs and symptoms characterised by the triad of microangiopathic haemolytic anaemia, thrombocytopaenia and acute renal failure.</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, as well as the clinical presentation:</p><p class="elsevierStylePara">- Typical HUS or HUS associated with the Shiga toxin (Stx) is the most common form of HUS (occurring in 90% of cases). It is caused by infection transmitted by food containing Shiga Toxigenic Escherichia coli. It usually occurs after an often bloody prodromal diarrhoea episode. It is usually self-limiting and normally has a benign course.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">- Atypical HUS or HUS not associated with Shiga toxin accounts for 10% of cases of HUS. The disease may occur sporadically (<20% of cases) or run in families. It is a heterogeneous group of disorders characterised clinically by the absence of diarrhoea in 92% of cases and a worse prognosis. Most patients have recurrences and over 50% develop stage 5 chronic kidney disease.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The diagnosis to establish the association between HUS and infection by Shiga Toxigenic Escherichia coli (STEC) is based on three criteria: isolation and characterisation of the pathogen, detection of free faecal Stx and anti-Stx antibodies in serum.<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. The diagnosis of the infection due to STEC should be carried out within 48 h of the time when diarrhoea began.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In our case, it was not possible to confirm diagnosis, since the patient came in six days after the symptoms began; however, given that the symptoms suggested infection by <span class="elsevierStyleItalic">E. coli</span> (abdominal pain and bloody diarrhoeal stools) along with thrombocytopenia, microangiopathic haemolytic anaemia (high LDH and decreased haemoglobin) and the onset of acute renal failure, as well as good patient evolution, we confirmed that this was a case of typical HUS.</p><p class="elsevierStylePara">When HUS is suspected, it is essential to start treatment immediately, since it usually progresses and causes irreversible renal failure, progressive neurological deterioration, cardiac ischaemia and even death.</p><p class="elsevierStylePara">In conclusion, we insist that the best way to reduce cases of HUS is prevention: more stringent controls at all points of the food chain that ensure compliance with all food science laws and regulations at all levels, along with educational policies for the population as a whole.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/11735_16025_46843_en_t111735.jpg" class="elsevierStyleCrossRefs"><img src="11735_16025_46843_en_t111735.jpg" alt="Graph displaying evolution"></img></a></p><p class="elsevierStylePara">Figure 1. 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Year/Month | Html | Total | |
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2024 November | 31 | 8 | 39 |
2024 October | 162 | 34 | 196 |
2024 September | 143 | 27 | 170 |
2024 August | 165 | 81 | 246 |
2024 July | 125 | 36 | 161 |
2024 June | 132 | 51 | 183 |
2024 May | 139 | 30 | 169 |
2024 April | 122 | 30 | 152 |
2024 March | 115 | 35 | 150 |
2024 February | 105 | 35 | 140 |
2024 January | 93 | 20 | 113 |
2023 December | 115 | 31 | 146 |
2023 November | 116 | 34 | 150 |
2023 October | 157 | 34 | 191 |
2023 September | 168 | 31 | 199 |
2023 August | 137 | 22 | 159 |
2023 July | 124 | 42 | 166 |
2023 June | 128 | 17 | 145 |
2023 May | 83 | 29 | 112 |
2023 April | 102 | 17 | 119 |
2023 March | 83 | 22 | 105 |
2023 February | 114 | 15 | 129 |
2023 January | 129 | 33 | 162 |
2022 December | 117 | 27 | 144 |
2022 November | 96 | 37 | 133 |
2022 October | 105 | 38 | 143 |
2022 September | 102 | 31 | 133 |
2022 August | 106 | 32 | 138 |
2022 July | 80 | 46 | 126 |
2022 June | 71 | 27 | 98 |
2022 May | 101 | 43 | 144 |
2022 April | 115 | 49 | 164 |
2022 March | 111 | 48 | 159 |
2022 February | 78 | 30 | 108 |
2022 January | 124 | 42 | 166 |
2021 December | 109 | 33 | 142 |
2021 November | 109 | 41 | 150 |
2021 October | 112 | 36 | 148 |
2021 September | 118 | 37 | 155 |
2021 August | 104 | 31 | 135 |
2021 July | 103 | 38 | 141 |
2021 June | 82 | 18 | 100 |
2021 May | 116 | 34 | 150 |
2021 April | 225 | 52 | 277 |
2021 March | 168 | 29 | 197 |
2021 February | 148 | 19 | 167 |
2021 January | 96 | 15 | 111 |
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 |