18Oct 2017

ONE CASE OF MANIFESTATION TROMBOTIC MICROANGIOPATHY.

  • Head of Department of critical care. The First University Clinic, MD, PhD. Prof.of TSMU (Tbilisi, Georgia).
  • Head of Department Nefrology. Prof.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Purpose: Presentation of one case of HUS. Shiga-like toxin producing E coli hemolytic-uremic syndrome (STEC-HUS) is a disorder that most often occurs when an infection in the digestive system produces toxic substances. These substances destroy red blood cells and cause kidney injury. Hemolytic-uremic syndrome (HUS) often occurs after a gastrointestinal infection with E .coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections andnongastrointestinal infections. atypical HUS(aHUS )is not infection-related. It is similar to another disease called thrombotic thrombocytopenic purpura TTP/TMA(tromboticmicroangiopathy)and is related to other diseases,lik lupus erythematosus ,antiphospholipidsyndrome.Haemolytic‐uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are two clinically similar disorders characterized by severe microangiopathic haemolytic anaemia and thrombocytopenia. Thus, the two disorders are often difficult to distinguish. We presented case discussion of 32 old wumen with bloody diarrhea,oligoanuria and changes of awareness. Rezults: Increased level of LDH,creatinine, urea. Decreased level of ADAMTS 13. Anisocytosis, shisocytosis ,poikilocytosis .Renal biopsy revield global sclerotic changes, In CSF was found HSV1 virus, After treatment patient state was improved .motor and sensoric activation was increazed. Spontan breathing parameters improuved. Later Patient state was worsened despite of suitable treatment developed pulmonary embolizm and inferior vena cava embolizm . Conclusion: In patients with HUS , the fraquency of mortality is high, clinical manifestation also is nontypical.Adequite estimations of clinical signs in premorbid period and examination of organ function after hospitalization,prevention and management of complications gives a real chance of convalescence


  1. Interventions for hemolytic-uremic syndrome and thrombotic-thrombocytopenic purpura,a systematic review of randomized contolled trials.Michaelem-AM j Kidney dis-01-Feb-2009;53(2):259-72
  2. Thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome and adult onset Still,s disease: case report and reviw of the literature-Say arioglu M-Mod Rheumatolo-01-jan-2008,18(4):403-6
  3. Is there a shared pathophysiology for TTP and HUS?-Desch K-j.AM Soc Nephrol-01 sep-2007;18(9):2457-60
  4. Therapeutic plasma exchange in patients with TTP-HUS :the 10 year experience of a single center.Kirn -Hematology -01-MAR-2011;16(2):73-9
  5. Platelet count and prothrombin time help distinguish thrombotic thrombocytopenic purpura-hemolytic uremic syndrome from DIC in adults.PARK IA-AM j Clin Pathol-01-MAR-2010;133(3):460-5
  6. Inherited ADAMTS13 deficiensy-unique presentation and treatment.-Born H-Pediatr Blood Cancer-01-MAY-2008;50(5):956-7
  7. Atypical hemolytic uremic syndrome-Kavanagh D-Curropin hematol-01-Sep-2010;15(5):432-8
  8. Rituximab therapy in two children with autoimmune thrombotic thrombocytopenic purpura-Albavamki JH ?pediatr nephrol-01-SEP-2009;24(9):1749-52
  9. Treating TTP-HUS with plasma exchange:a single centre,s 25 year experience?Forzley BR J Haematolol-01-oct-2008;143(1):100-6
  10. Thrombotic microangiopathy(TTP and HUS):advances in differentiation and diagnosis.Schneide M-Clin Lab SCI-oi-oct-2007;20(4):216-20
  11. Elevated procalcitonin and C reaqtive protein as potential biomarkers of Sepsis in subpopulation of thrombotic microangiopathypatients.Erickson YO-j clin?????? ?pher-01-jan-2009;24(4):150-4
  12. HUS-TTP update:2008.Clark WF-Kidney int Suppl-01-Feb-2009(112):91-3
  13. Atypical Hemolytic-Uremic Syndrome: A Case Report and Literature Review
  14. ArsalanRafiq,A,B,C,D,E,FHassan Tariq,A,B,C,E,F?NaeemAbbas,E,F?and?RoopalekhaShenoyA,E,,Am J Case Rep. 2015; 16: 109?114.Published online 2015 Feb 24.?doi:??12659/AJCR.8929072
  15. Anti-Factor H Autoantibody?Associated Hemolytic Uremic Syndrome: Review of Literature of the Autoimmune Form of HUS. Marie-Agnes Dragon-Durey,CarolineBlanc,Nature reviews Nephrology8,622-633, November2012 ,doi:10.1038/neph. 2012.
  16. Platelet count and prothrombin time help distinguish thrombotic thrombocytopenic purpura-hemolytic uremic syndrome from DIC in adults.PARK IA-AM j Clin Pathol-01-MAR-2010;133(3):460-5
  17. Therapeutic plasma exchange in patients with TTP-HUS :the 10 year experience of a single center.Kirn -Hematology -01-MAR-2011;16(2):73-9
  18. Atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: clinically differentiating the thrombotic microangiopathies. Nester CM, Thomas CP.Eur J Intern Med.?2013;24(6):486?91.?[PubMed]
  19. Diagnostic criteria for atypical hemolytic uremic syndrome proposed by the Joint Committee of the Japanese Society of Nephrology and the Japan Pediatric Society.?2014;18(1):4?9.?[PubMed]
  20. Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome.Bauer A, Loos S, Wehrmann C, et al. PediatrNephrol 2014; 29:1607.
  21. Thrombotic microangiopathy(TTP and HUS):advances in differentiation and diagnosis.Schneide M-Clin Lab SCI-oi-oct-2007;20(4):216-20
  22. Interventions for hemolytic-uremic syndrome and thrombotic-thrombocytopenic purpura,a systematic review of randomized contolled trials.Michaelem-AM j Kidney dis-01-Feb-2009;53(2):259-72
  23. A Case Report and Literature Review of Eculizumab Withdrawal in Atypical HemolyticUremic Syndrome. BorjaQuiroga ,Alberto de Lorenzo ,Cristina Vega ,Fernando de Alvaro, Am J Case Rep, 2016; 17: 950-956
  24. Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome.Nathanson S, Kwon T, Elmaleh M, et al. Clin J Am SocNephrol 2010; 5:1218.
  25. Atypical hemolytic uremic syndrome-Kavanagh D-Curropin hematol-01-Sep-2010;15(5):432-8

[Guliko Kiliptari and Merab Sutidze. (2017); ONE CASE OF MANIFESTATION TROMBOTIC MICROANGIOPATHY. Int. J. of Adv. Res. 5 (Oct). 831-838] (ISSN 2320-5407). www.journalijar.com


Merab Sutidze2


DOI:


Article DOI: 10.21474/IJAR01/5593      
DOI URL: http://dx.doi.org/10.21474/IJAR01/5593