RENAL HISTOPATHOLOGY IN FATAL CASES OF DIARRHEA-ASSOCIATED HEMOLYTIC-UREMIC SYNDROME

Autopsy material was examined from British children dying early in the course of haemolytic uraemic syndrome (HUS). These presented after 19 83, the period in which verocytotoxin-producing Escherichia coli (VTEC ) infection was confirmed as the leading cause of diarrhoea-associated (D+HUS) in the United Kingdom. Of 18 cases referred for this study, 3 were found on review to have no history of a diarrhoeal prodrome (D-H US). In the D+ patients, the median duration from onset of diarrhoea t o death was 8 days (range 4-42 days). VTEC infection was confirmed in 6 cases. All had neutrophilia at presentation (median 21, range 15-49. 8 x 10(9)/l). The 15 cases had uniform pathological features, consisti ng of glomerular thromboses and congested rather than ischaemic glomer uli. Arteriolar thromboses were common at the hilum of glomeruli and w ere sometimes also seen proximally, including in interlobular arteries . There were cortical infarcts in 5 cases with extensive thrombosis. C ases were demonstrated to have significantly greater numbers of neutro phils expressed per 100 glomeruli than controls, when counted using im munohistological stains to neutrophil elastase and CD15. This study sh owed uniformity of the renal changes in D+HUS and gave further evidenc e of the importance of neutrophils in the pathogenesis of the disease.