Srivastava R N, Moudgil A, Bagga A, Vasudev A S
Department of Pediatrics, All India Institute of Medical Sciences New Delhi.
Pediatr Nephrol. 1991 May;5(3):284-8. doi: 10.1007/BF00867477.
We observed 73 patients with the hemolytic uremic syndrome (HUS) in 9 years (1980-1988), comprising 34% of patients with acute renal failure treated over the same period. There were 53 boys and 20 girls; 59% were below the age of 2 years and 33% between 2 and 5 years. Acute, usually severe dysentery, responding poorly to various antibiotics, was the prodromal illness in 80%, whereas 12% had watery diarrhea. Most patients had severe renal involvement with anuria in 56% and oliguria in 30%. A polymorphonuclear leukocytosis was present in 85% of cases, but had no correlation with the highest levels of blood urea. Coagulation abnormalities suggesting consumption coagulopathy were found in 24 of 30 cases. The results of stool culture showed Shigella species in 7 cases and nontyphoidal Salmonella in 9. Escherichia coli were isolated in 11 cases, but were not further characterized. Renal biopsy showed total or patchy cortical necrosis in 20 of 50 cases. The patients were managed with supportive care, including transfusion of fresh blood or plasma and dialysis as required. The mortality was 60%, being chiefly related to the duration of renal failure and presence of renal cortical necrosis, whereas persistent dysentery and infections were complicating factors. The presence of convulsions and coagulation defects had no relation to the outcome. Our observations indicate that HUS in children in northern India is mostly related to dysentery, likely to be shigellosis, and is usually associated with severe renal damage and a high death rate.
在9年（1980 - 1988年）间，我们观察了73例溶血尿毒综合征（HUS）患者，占同期治疗的急性肾衰竭患者的34%。其中男孩53例，女孩20例；59%的患者年龄在2岁以下，33%的患者年龄在2至5岁之间。前驱疾病通常为急性且严重的痢疾，对各种抗生素反应不佳，80%的患者患有此病，而12%的患者有水样腹泻。大多数患者有严重的肾脏受累，56%的患者无尿，30%的患者少尿。85%的病例存在多形核白细胞增多，但与血尿素的最高水平无关。30例中有24例发现提示消耗性凝血病的凝血异常。粪便培养结果显示，7例为志贺菌属，9例为非伤寒沙门菌。11例分离出大肠杆菌，但未进一步鉴定。50例中有20例肾活检显示全皮质或局灶性皮质坏死。患者接受支持性治疗，包括根据需要输注新鲜血液或血浆以及进行透析。死亡率为60%，主要与肾衰竭持续时间和肾皮质坏死的存在有关，而持续性痢疾和感染是并发症因素。惊厥和凝血缺陷的存在与预后无关。我们的观察表明，印度北部儿童的溶血尿毒综合征大多与痢疾有关，可能是志贺菌病，通常伴有严重的肾损害和高死亡率。
