RESUMEN
AIM: Identifying early clinical and biological factors associated with severe forms of postdiarrheal hemolytic uremic syndrome (D+HUS) that may help practitioners determine appropriate treatment. METHODS: This retrospective study was conducted in 49 children with D+HUS between 2001 and 2011. Severe forms were defined as occurrence of one of the following conditions: death, major neurological involvement, cardiovascular involvement, and/or the presence of sequelae (neurological, cardiovascular, pancreatic, or renal). RESULTS: During the acute phase, 35 children exhibited at least one type of extrarenal involvement including 13 severe forms with a median delayed occurrence after admission of 4.5 days (range: 1-8) for comatose children and 5 days (range: 2-6) for cardiovascular involvement; 32 children required dialysis and three died. In multivariate analysis, (i) major neurological involvement (n=13), (ii) dialysis (n=32), and (iii) sequelae (n=12) were associated with (i) fever during the prodromal phase requiring dialysis at admission, (ii) C-reactive protein level (CRP) >22mg/L at admission, and (iii) major neurological involvement and a white blood cell count (WBC)>20×103/mm3 during the acute stage, respectively. CONCLUSIONS: D+HUS is a multiorgan disease with a delayed occurrence of life-threatening extrarenal organ involvement. Severe forms appear to be associated with early biological and clinical inflammatory parameters.
Asunto(s)
Diarrea/complicaciones , Síndrome Hemolítico-Urémico/complicaciones , Insuficiencia Multiorgánica/etiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis observed in only a few cases in children. Symptoms are mild, which explains the delay in diagnosis. Diagnosis is based on histology but can be suspected on CT. The treatment is medical and often surgical, with an uncertain renal prognosis. It is therefore imperative to diagnose early. We report the case of a 4-year-old child who presented with xanthogranulomatous pyelonephritis caused by Pseudomonas aeruginosa, which evolved into pyonephrosis, due to inadequate antibiotic therapy. This highlights the importance of understanding this disease and not treating urinary tract infections blindly.