ACUTE-RENAL-FAILURE DUE TO HEMOLYTIC-UREMIC SYNDROME IN ADULT PATIENTS

Hemolytic uremic syndrome is characterized by the simultaneous occurre nce of hemolytic anemia, thrombocytopenia, and renal failure. Clinical /pathologic data, along with the treatment and outcome of 8 adult pati ents with HUS, are described. There were 7 females and 1 male, age 30. 7 +/- 12 years; 7 were White and 1 Black. Three patients were kidney g raft recipients, 2 of whom were receiving cyclosporine; 2 patients wer e postpartum; 1 case followed an abortion; 1 occurred with prodromic i nfection; and 1 case was without a causal factor All patients presente d with hematuria and 6 with oligoanuria. Laboratory data showed hemoly tic anemia with schistocytes, LDH values were 2584 +/- 2191 U/L, plate lets were 79,000 +/- 40,000/mL, creatinine concentrations were 5.9 +/- 2.5 mg/dL. Renal biopsy showed thrombotic microangiopathy. Two had pr edominant glomerular involvement, 2 showed renal cortical necrosis, 4 were marked by predominant arteriolar involvement. In 5 patients dialy tic therapy was performed. All were treated with fresh-frozen plasma i nfusion and 6 with plasmapheresis. Three patients died, 2 without reco very of renal function. In conclusion, the trigger events were related to renal transplant in 3, 2 of them taking cyclosporine; 3 with pregn ancy; 1 to precedent infection; and 1 with no causal factor. There was no correlation between histological form and outcome in this group of patients. The benefit of plasmapheresis was evident in the recovery o f the extrarenal manifestations, although tt did not change the renal outcome. The prognosis is poor, with a high mortality (37.5%) and/or e nd-stage renal failure (37.5%). Complete recovery of renal function wa s obtained in 25%.