Kh.S. KHAERTYNOV¹, V.A. ANOKHIN¹, S.V. KHALIULLINA¹, E.Yu. ALATYREV², G.M. KURBANOVA², G.V. ZAYALOVA¹

¹Kazan State Medical University of the Ministry of Health of the Russian Federation, Kazan

²Republic Clinical Infectious Hospital named after Prof. A.F. Agafonov, Kazan

Contact:

Khayertynov Kha.S. — PhD (medicine), Associate Professor of the Department of Children’s Diseases

Address: 49 Butlerov Str., 420012, Kazan, Russian Federation, tel. +7-903-342-96-27, e-mail: khalit65@rambler.ru

 The study objective was to assess the clinical and laboratory features of a typical hemolytic uremic syndrome (HUS) in children in the early stages of the disease.

Material and methods. 13 cases of children with diarrhea-associated hemolytic-uremic syndrome were analyzed. 2 children were younger than one year old, 7 children — from 1 to 3 years old, and 4 children — from 3 to 5 years old.

Results. The most frequently reported clinical manifestations at admission were: fever, vomiting, hemorrhagic syndrome and dehydration, observed in 92%, 85%, 54% and 46% of cases, respectively. 7 children (54%) had bloody stools. Four children had “coffee-ground” vomit, three children had a petechial rash on the skin. 10 out of 13 patients had thrombocytopenia at admission, and in 69% of cases the platelet count was less than 100 × 10⁹/l. The median platelet count was 51 × 10⁹/l [CI 41-101]. A decrease of hemoglobin level less than 105 g/l at admission was detected in 6 (46%) children. A biochemical blood analysis revealed an increase of bilirubin above 21 μmol/l in 4 patients (31%). In 9 children (69%), an increase of alanine aminotransferase of more than 40 U/l was recorded (median of 121.5 U/l, CI 54-140.5). An increase in blood levels of urea and creatinine was observed in all 13 patients (the median level of urea was 24.3 mmol /l, CI 21.7-28.6, and creatinine — 276 μmol /l, CI 170-323.5).

Conclusion. The study showed that HUS may be caused by processes not associated with microorganisms producing Shiga-toxin. Thrombocytopenia and an increase in blood levels of urea and creatinine are early laboratory manifestations of HUS in children.

Key words: diarrhea, hemolytic-uremic syndrome, children.

(For citation: Khaertynov Kh.S., Anokhin V.A., Khaliullina S.V., Alatyrev E.Yu., Kurbanova G.M., Zayalova G.V. Diarrhea-associated hemolytic-uremic syndrome in children. Practical Medicine. 2020. Vol. 18, № 2, P.)

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