title: First-Line, Early and Long-Term Eculizumab Therapy in Atypical Hemolytic Uremic Syndrome: A Case Series in Pediatric Patients.
abstract: BACKGROUND
  Studies relating to first-line, early, and long-term eculizumab treatment and outcomes in children with atypical hemolytic uremic syndrome (aHUS) are scarce and unclear. The aim of this case-series study was to evaluate the outcomes of first-line, early, and long-term eculizumab treatment in our aHUS patients.
  
  
  METHODS
  We reviewed the data from four pediatric patients with aHUS who were treated with eculizumab. In three of them, eculizumab was used as a first-line therapy, and the follow-up period was ≥2 years in three patients.
  
  
  RESULTS
  Plasma exchange could not be performed in any patient. Plasma infusions were used only in Patient 1 (a 14-month-old boy) for 8 days without any response. Therefore, eculizumab was started on day 11 after admission. Patient 2 (a 16-month-old boy), Patient 3 (an 11-year-old girl), and Patient 4 (a 32-month-old girl) were treated with eculizumab as a first-line therapy, which was started 2-4 days after admission. The dosage of eculizumab was adjusted according to body weight. The hematologic parameters (the time frames were 3-17 days) and C3(the time frames were 10-17 days) returned to normal in all patients after receipt of eculizumab. Although Patient 1 developed stage III chronic kidney disease, complete renal recovery occurred in Patients 2 and 4. Patient 3 also had reflux nephropathy with bilateral grade III vesicoureteral reflux and renal scars. Her creatinine clearance returned to the baseline value after receiving eculizumab. No complications related to eculizumab were observed in any patient during the follow-up period.
  
  
  CONCLUSIONS
  Eculizumab can be successfully used as a first-line therapy in pediatric aHUS patients. We observed that the early initiation of eculizumab was associated with the complete recovery of renal function.
authors.affiliation: Department of Pediatric Nephrology, Pamukkale University School of Medicine, Kınıklı, Denizli, Turkey. selcukyuksel.nephrology@gmail.com.
authors.forename: Selçuk
authors.initials: S
authors.lastname: Yüksel
authors.affiliation: Department of Pediatric Nephrology, Pamukkale University School of Medicine, Kınıklı, Denizli, Turkey.
authors.forename: Havva
authors.initials: H
authors.lastname: Evrengül
authors.affiliation: Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Z Birsin
authors.initials: ZB
authors.lastname: Özçakar
authors.affiliation: Department of Pediatric Nephrology, Pamukkale University School of Medicine, Kınıklı, Denizli, Turkey.
authors.forename: Tülay
authors.initials: T
authors.lastname: Becerir
authors.affiliation: Department of Pathology, Pamukkale University School of Medicine, Denizli, Turkey.
authors.forename: Nagihan
authors.initials: N
authors.lastname: Yalçın
authors.affiliation: Department of Pediatric Nephrology and Nephrogenetics Laboratory, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Korkmaz
authors.affiliation: Department of Pediatric Nephrology and Nephrogenetics Laboratory, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozaltin
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D065766:Atypical Hemolytic Uremic Syndrome / Q000188:drug therapy*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C481642:eculizumab