Endarterial urokinase in childhood hemolytic uremic syndrome.

Urokinase was given by unilateral infusion for 48-168 hours into the renal arteries of 8 children (0.2 to 13.0 years) with acute renal failure and impaired renal perfusion due to hemolytic uremic syndrome (HUS). Two children subsequently received a bilateral infusion. Immediate changes in renal perfusion were assessed by serial dynamic renal scanning in all patients and by repeat renal arteriography in 5. No improvement clearly attributable to urokinase was observed. In 4 surviving children assessment of divided renal function by static renal scanning 1 to 5 years after presentation showed no evidence of benefit from urokinase. Examination of the kidneys of 2 of the 3 children who died, and one who underwent bilateral nephrectomy prior to renal transplantation, showed no evidence of benefit from urokinase. Examination of the kidneys of 2 of the 3 children who died, and one who underwent bilateral nephrectomy prior to renal transplantation, showed no preservation of renal mass attributable to urokinase; in one of these children the infused kidney was considerably smaller than the untreated kidney. It is concluded that local infusion of urokinase had no beneficial effect on the course of HUS in these children.