Document Detail

Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome.
MedLine Citation:
PMID:  20498239     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Neurologic involvement is the most threatening complication of diarrhea-associated hemolytic uremic syndrome (D+HUS).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We report a retrospective multicenter series of 52 patients with severe initial neurologic involvement that occurred in the course of D+HUS.
RESULTS: Verotoxigenic Escherichia coli infection was documented in 24. All except two patients had acute renal failure that required peritoneal dialysis, hemodialysis, or both techniques. A first group of eight patients remained with normal consciousness; five of them had protracted seizures. A second group of 23 patients had stuporous coma; five of these had protracted severe seizures, and 18 had a neurologic defect including pyramidal syndrome, hemiplegia or hemiparesia, and extrapyramidal syndrome. A third group of 21 patients had severe coma. Plasma exchanges were undertaken in 25 patients, 11 of whom were treated within 24 hours after the first neurologic sign; four died, two survived with severe sequelae, and five were alive without neurologic defect. Magnetic resonance imaging (MRI) for 29 patients showed that (1) every structure of the central nervous system was susceptible to involvement; (2) no correlation seemed to exist between special profile of localization on early MRI and the final prognosis; and (3) MRI did not exhibit any focal lesions in three patients. The overall prognosis of the series was marked by the death of nine patients and severe sequelae in 13.
CONCLUSIONS: Neurologic involvement is associated with a severe renal disease but does not lead systematically to death or severe disability.
Sylvie Nathanson; Thérésa Kwon; Monique Elmaleh; Marina Charbit; Emma Allain Launay; Jérôme Harambat; Muriel Brun; Bruno Ranchin; Flavio Bandin; Sylvie Cloarec; Guylhene Bourdat-Michel; Christine Piètrement; Gérard Champion; Tim Ulinski; Georges Deschênes
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2010-05-24
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  5     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-08     Completed Date:  2010-10-26     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1218-28     Citation Subset:  IM    
Pediatric Unit, Hôpital Mignot, 177 rue de Versailles, F-78150 le Chesnay, France.
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MeSH Terms
Acute Kidney Injury / microbiology*,  mortality,  therapy
Child, Preschool
Coma / microbiology
Diarrhea / microbiology*,  mortality,  therapy
Disability Evaluation
Dystonia / microbiology
Escherichia coli Infections / complications,  microbiology*,  mortality,  therapy
Hemolytic-Uremic Syndrome / microbiology*,  mortality,  therapy
Magnetic Resonance Imaging
Nervous System Diseases / diagnosis,  microbiology*,  mortality,  therapy
Paresis / microbiology
Peritoneal Dialysis
Plasma Exchange
Renal Dialysis
Retrospective Studies
Seizures / microbiology
Severity of Illness Index
Shiga-Toxigenic Escherichia coli / pathogenicity*
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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