How is haemolytic-uremic syndrome treated?

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

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

In hemolytic-uremic syndrome, early hemodialysis is necessary, 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-electrolyte metabolism. In these cases daily hemodialysis is shown throughout the oligoanuria period. If hemodialysis is not possible, replace blood transfusions, multiple flushes of the stomach and intestines. Replaced blood transfusion should be carried out as early as possible. Because 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 start the replacement blood transfusions from the introduction of washed red blood cells diluted in an antibody-free albumin solution and only then switch to whole blood administration. In the absence of washed red blood cells, replacement blood transfusions can be performed using freshly heparinized whole blood. During continued hemolysis, when hemoglobin content is lower than 65-70 g / l, transfusion therapy with freshly heparinized blood (3-5 ml / kg) is shown, regardless of transfusion. It should be noted that in the blood stored for more than 7-10 days, there is an accumulation of a significant amount of potassium from the erythrocytes. At a low level of antirembina III, even against a background of normal or increased free heparin content, replacement therapy with components of blood containing antithrombin III is of paramount importance. The greatest amount is stored in fresh frozen, less in native (canned) plasma. The dose of the drug is 5-8 ml / kg (per infusion).

At a normal level of antithrombin III or after its correction, heparin therapy begins, it is necessary to maintain a constant level of heparinization with a continuous infusion of heparin 15 U / kg kg. The effect of anticoagulant therapy is estimated by the time of blood coagulation according to Li-Whit every 6 hours. If the clotting time n is "prolonged, the dose of heparin should be increased to 30-40 U / (kg x h). If the clotting time is longer than 20 minutes, the dose of heparin is reduced to 5-10 U / (kg x h). After selecting an individual dose of heparin, heparin therapy is continued in this mode. As the patient's condition improves, tolerance to heparin may change, so it is necessary to continue daily regular monitoring. The elimination of heparin is carried out with a gradual decrease in the dose for 1-2 days in order to avoid the development of hypercoagulable and "ricochet effect."

In recent years, along with anticoagulant therapy, antiplatelet agents are used: acetylsalicylic acid, dipyridamole (quarantil). Usually they are assigned simultaneously in connection with their different mechanism of action.

Corticosteroid therapy is rejected by most authors, as it increases hypercoagulation and blocks the "purifying" function of the reticuloendothelial system like the first endotoxin injection in the Sa-Narelli-Schwarzmann phenomenon.

When hemolytic-uremic syndrome against the background of infectious diseases, patients are prescribed antibiotics that do not possess nephrohepato-toxic properties. It is better to use penicillin-type drugs.

• Treatment in the polyuric phase.

It is necessary to correct losses of water and electrolytes, first of all, ions of potassium and sodium, the purpose of which should be approximately 2 times higher than their excretion.

Antioxidant therapy with vitamin E.

Forecast

When the duration of the oligoanuscular period is more than 4 weeks, the prognosis for recovery is uncertain. Prognostically unfavorable clinical and laboratory signs are persistent neurological symptoms and the absence of a positive reaction to the first 2-3 sessions of hemodialysis. In previous years almost all children of early age with hemolytic-uremic syndrome died, but with the use of hemodialysis, the mortality rate decreased to 20%.

[1], [2], [3]