How is acute renal failure treated in pediatric hemolytic uremic syndrome (HUS)?

Updated: Nov 12, 2018
  • Author: Robert S Gillespie, MD, MPH; Chief Editor: Craig B Langman, MD  more...
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Answer

Approximately 50% of patients with STEC-HUS require a period of dialysis. Consider early dialysis if the patient develops fluid overload, hyperkalemia, acidosis, hyponatremia, or oligoanuria that is unresponsive to diuretics.

Any type of dialysis or related technique (eg, hemofiltration) may be used, depending on local availability and individual patient factors. Suitable techniques include peritoneal dialysis, hemodialysis, or continuous renal replacement therapies (CRRT).

Peritoneal dialysis is widely used for pediatric patients. Peritoneal dialysis is usually well tolerated and is technically easier, especially in small infants.

Hemodialysis is also suitable for children. Hemodialysis may be preferable in patients with severe abdominal pain, in whom intestinal edema and pain may reduce achievable fill volumes. The intense visceral inflammation may lead to ultrafiltration failure. Omentectomy and placement of a peritoneal catheter may worsen their pain and complicate evaluation of continued pain.

Abdominal pain is more complex to assess in patients with a new peritoneal catheter. Pain could be due to a catheter-related complication, dialysis-associated peritonitis, or critical complications of hemolytic-uremic syndrome, such as intestinal perforation.

CRRT may be preferable for hemodynamically unstable patients. CRRT allows very precise control of volume status. CRRT also circumvents the issue of abdominal pain discussed above.

A growing body of evidence from critically ill patients shows that volume overload is a major contributor to morbidity and mortality. [10, 11] Initiate dialysis promptly if patient has, or is approaching, a state of fluid overload.

Dialysis does not alter the course of the disease; it only supports the patient while awaiting resolution of the illness. Early dialysis as a preventive or therapeutic measure is not justified. Current data do not support a previous theory that peritoneal dialysis could improve outcomes by removal of plasminogen-activator inhibitor type 1 (PAI-1). However, several studies support early use of dialysis when indicated to optimize fluid, electrolyte, or nutritional status.

Patients who require dialysis usually need 5-7 days of therapy, although this number widely varies.


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