SERUM-PROTEINS IN THE HEMOLYTIC-UREMIC SYNDROME

In 122 patients with the haemolytic uraemic syndrome (HUS), serum prot eins were analysed in the acute phase of the disease (n = 122) and 6 w eeks (n = 57) and 6 months (n = 84) later. Total serum protein levels were significantly lower on admission than 6 weeks and 6 months later (P < 0.0001). The same was true for median values of serum albumin (P < 0.0001), alpha(2)-globulins (P < 0.0001) and gamma-globulins (P < 0. 001). There was no difference in beta-globulins, whereas the alpha(1)- globulins were significantly higher in the acute phase (P < 0.0001). T here was a significant positive correlation between age and total prot ein and gamma-globulin levels. Serum total protein and albumin levels displayed a significant positive correlation with serum sodium levels and a significant negative correlation with urinary protein excretion. Patients with oligoanuria had significantly lower serum albumin and s ignificantly higher alpha(1)-globulin levels than those with preserved urine production. Marked differences were observed between patients w ith (D+) and patients without (D-) prodromal diarrhoea. In D(-) HUS, o nly albumin and total protein levels were lower on admission, but to a lesser degree than in D(+) HUS. Serum (1)-globulin levels were signif icantly higher and alpha(2)-globulin levels significantly lower in D() HUS than D(-) HUS. In the D(+) subgroup of patients, by far the larg est, there was a significant positive correlation between serum albumi n and total protein on the one hand and the duration of the prodrome o n the other. Patients with bloody stools had significantly lower serum albumin and total protein levels than those without. Faecal alpha(1)- antitrypsin concentration measured in 12 HUS patients on admission was found to be significantly increased compared with age-matched control s. This study confirms the existence of hypoproteinaemia in childhood HUS and indicates that intestinal protein loss is an important, albeit not the only, physiopathological mechanism.