THE ROLE OF PLASMA-EXCHANGE IN THE TREATMENT OF SEVERE FORMS OF HEMOLYTIC-UREMIC SYNDROME IN CHILDHOOD

Therapeutic plasma exchange (PE) or plasmapheresis has been used in re cent years in the treatment of severe hemolytic uremic syndrome (HUS) in children. We analyzed the benefit of PE and peritoneal dialysis (PD ) in 9 children, 6 boys and 3 girls, aged 1-10 years, from 1983-1993. All children came from different geographical regions, and all had the sporadic form of the illness. Three patients had the gastrointestinal form, 5 had respiratory prodromes while 1 child developed RUS during the course of varicella. Seven children were hypertensive, but only in 3 was hypertension persistent. The child with varicella had a transie nt complement decrease. Five children were treated with PE. In 4 child ren, fresh frozen plasma (FFP) was used as replacement fluid, and huma n albumin was used in 1 child. Four children were treated with PD and infusions of FFP. Rapid recovery of renal function was observed in 5 p atients whereas in 2 oliguric children the recovery of renal function ensued within 1 and 2 months, respectively. Two children developed ter minal renal failure (TRF) (in 1 child the treatment was very delayed, and in the other child HUS developed following varicella). Only 1 boy had relapses of the disease followed by impairment of renal function f rom which he gradually recovered. During the 3-10 year follow-up perio d, only the child with relapses was hypertensive while the others had normal clinical and laboratory parameters. We suggest that PE plays an important role in the early treatment of severe forms of HUS in child ren.