How is hemolytic uremic syndrome treated?

Treatment of hemolytic uremic syndrome depends on the period of the disease and the severity of kidney damage.

• Treatment during anuria includes methods of extrarenal detoxification, replacement (antianemic) and symptomatic therapy.

In hemolytic-uremic syndrome, hemodialysis should be used as early as possible, regardless of the degree of uremic intoxication. Hemodialysis with general heparinization and transfusion of freshly heparinized blood allows interrupting disseminated intravascular coagulation and hemolysis, while normalizing water and electrolyte balance. In these cases, daily hemodialysis is indicated throughout the entire period of oligoanuria. If hemodialysis is impossible, exchange blood transfusions and multiple gastric and intestinal lavage are recommended. Exchange blood transfusions should be performed as early as possible. Since the blood of children with hemolytic-uremic syndrome contains altered erythrocytes that can be agglutinated by antibodies contained in the transfused plasma, it is advisable to begin exchange blood transfusions with the introduction of washed erythrocytes diluted in an antibody-free albumin solution, and only then switch to the introduction of whole blood. In the absence of washed red blood cells, replacement transfusions can be performed using freshly heparinized whole blood. During ongoing hemolysis, when the hemoglobin content drops below 65-70 g/l, transfusion therapy with freshly heparinized blood (3-5 ml/kg) is indicated, regardless of transfusions. It should be taken into account that in blood stored for more than 7-10 days, a significant amount of potassium accumulates from red blood cells. With a low level of antithrombin III, even with a normal or increased content of free heparin, replacement therapy with blood components containing antithrombin III is of primary importance. The greatest amount is preserved in fresh frozen plasma, less in native (preserved) plasma. The dose of the drug is 5-8 ml/kg (per infusion).

If the antithrombin III level is normal or after its correction, heparin therapy is started; it is necessary to maintain a constant heparinization level with a continuous infusion of heparin 15 U/(kg x h). The effect of anticoagulant therapy is assessed by the Lee-White blood clotting time every 6 hours. If the clotting time is not prolonged, the heparin dose should be increased to 30-40 U/(kg x h). If the clotting time is prolonged over 20 minutes, the heparin dose is reduced to 5-10 U/(kg x h). After selecting an individual heparin dose, heparin therapy is continued in the same regimen. As the patient's condition improves, tolerance to heparin may change, so it is necessary to continue daily regular monitoring. Heparin is discontinued with a gradual dose reduction over 1-2 days to avoid the development of hypercoagulation and a "rebound effect".

In recent years, along with anticoagulant therapy, antiplatelet agents have been used - acetylsalicylic acid, dipyridamole (curantil). They are usually prescribed simultaneously due to their different mechanisms of action.

Corticosteroid therapy is rejected by most authors, since it increases hypercoagulation and blocks the “cleansing” function of the reticuloendothelial system, similar to the first injection of endotoxin in the Sanarelli-Schwartzmann phenomenon.

In case of hemolytic uremic syndrome against the background of infectious diseases, patients are prescribed antibiotics that do not have nephrohepatotoxic properties. It is better to use penicillin-type drugs.

• Treatment during the polyuric phase.

It is necessary to correct the loss of water and electrolytes, primarily potassium and sodium ions, the intake of which should be approximately 2 times greater than their excretion.

Antioxidant therapy with vitamin E is indicated.

Forecast

If the oligoanuric period lasts more than 4 weeks, the prognosis for recovery is questionable. Prognostically unfavorable clinical and laboratory signs are persistent neurological symptoms and the absence of a positive response to the first 2-3 hemodialysis sessions. In previous years, almost all young children with hemolytic uremic syndrome died, but with the use of hemodialysis, the mortality rate has decreased to 20%.

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