Plasma infusion for hemolytic-uremic syndrome in children: results of a multicenter controlled trial.
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 randomly assigned to treatment with plasma or symptomatic therapy. Thirty-two children ranging 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-PGF1 alpha, 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 follow-up is needed to ascertain whether the presence of endothelial damage, demonstrated by electron microscopy in children who were not given plasma, is of clinical relevance.
Rizzoni
G
G
Paediatric Department, University of Padova, Italy.
Claris-Appiani
A
A
Edefonti
A
A
Facchin
P
P
Franchini
F
F
Gusmano
R
R
Imbasciati
E
E
Pavanello
L
L
Perfumo
F
F
Remuzzi
G
G
D001706:Biopsy; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D011464:Epoprostenol / Q000096:biosynthesis; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D065227:Transfusion Reaction
D011464:Epoprostenol