The results of a controlled trial to ascertain the usefulness of plasma infusion for the treatment of hemolytic-uremic syndrome (HUS) are reported. Criteria for admission were (1) observation within 8 days from first symptoms, (2) dialysis treatment required, and (3) no special treatments and no more than 25 ml blood/kg previously received. Children were subdivided according to age (less than or more than 3 years) and then randonmly assigned to treatment with plasma or symptomatic therapy. Thirty-two children raning in age from 4 months to 6 years entered this study; 17 received plasma (P+group) and 15 only symptomatic therapy (P-group). The mean follow-up period was 16 months in both groups. Surgical renal biopsy was performed 29 to 49 days after onset in 11 P+ and 11 P- children, and 33 histologic findings were semiquantitatively evaluated. No death occurred in either group. No differences were found in blood pressure, proteinuria, or hematuria at the end of the follow-up period; in no case were severe arteriolar lesions found. There were no significant differences for the scores of the individual histologic measurements; on electron microscopy, no vascular changes were observed in seven children of the P+group, whereas in five of seven of the P-group, thickening of the lamina rara interna and arteriolar damage were present. The ability of plasma to stimulate prostacyclin (PGI2) production, measured as its stable derivative 6-keto-PGF was within the normal range for all patients. In our patients with predominant glomerular involvement who were treated in a very early phase of HUS, infusions of plasma did not significantly influence the short- and medium- term clinical outcome and were not effective in severe HUS when given later in the course of the disease. A longer floow-up is needed to ascertain whether the presence of endothelial damage, demonstarted by electron microscopy in children who were not given plasma, is of clinical relevance.
Plasma infusion for hemolityc uraemic syndrome in children: results of a multicenter controlled trial
FACCHIN, PAOLA;
1988
Abstract
The results of a controlled trial to ascertain the usefulness of plasma infusion for the treatment of hemolytic-uremic syndrome (HUS) are reported. Criteria for admission were (1) observation within 8 days from first symptoms, (2) dialysis treatment required, and (3) no special treatments and no more than 25 ml blood/kg previously received. Children were subdivided according to age (less than or more than 3 years) and then randonmly assigned to treatment with plasma or symptomatic therapy. Thirty-two children raning in age from 4 months to 6 years entered this study; 17 received plasma (P+group) and 15 only symptomatic therapy (P-group). The mean follow-up period was 16 months in both groups. Surgical renal biopsy was performed 29 to 49 days after onset in 11 P+ and 11 P- children, and 33 histologic findings were semiquantitatively evaluated. No death occurred in either group. No differences were found in blood pressure, proteinuria, or hematuria at the end of the follow-up period; in no case were severe arteriolar lesions found. There were no significant differences for the scores of the individual histologic measurements; on electron microscopy, no vascular changes were observed in seven children of the P+group, whereas in five of seven of the P-group, thickening of the lamina rara interna and arteriolar damage were present. The ability of plasma to stimulate prostacyclin (PGI2) production, measured as its stable derivative 6-keto-PGF was within the normal range for all patients. In our patients with predominant glomerular involvement who were treated in a very early phase of HUS, infusions of plasma did not significantly influence the short- and medium- term clinical outcome and were not effective in severe HUS when given later in the course of the disease. A longer floow-up is needed to ascertain whether the presence of endothelial damage, demonstarted by electron microscopy in children who were not given plasma, is of clinical relevance.Pubblicazioni consigliate
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