Encore d’actualité ! Escherichia coli et syndrome hémolytique et urémique chez l’enfant et l’adulte

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• 作者：Q. Raimbourg (1)
  G. d’Ythurbide (2)
  E. Rondeau (2)
  
• 关键词：Syndrome hémolytique et urémique ; Shigatoxines ; Insuffisance rénale ; Eculizumab ; Hemolytic uremic syndrome ; Shiga ; toxin ; Renal failure ; Eculizumab
• 刊名：R篓娄animation
• 出版年：2012
• 出版时间：May 2012
• 年：2012
• 卷：21
• 期：3
• 页码：280-285
• 全文大小：122KB
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• 作者单位：Q. Raimbourg (1)
  G. d’Ythurbide (2)
  E. Rondeau (2)
  
  1. Service de néphrologie, h?pital Bichat-Claude-Bernard, 46, rue Henri-Huchard, F-75877, Paris cedex 18, France
  2. Service des urgences néphrologiques et transplantation rénale, h?pital Tenon, 4, rue de la Chine, F-75020, Paris, France
  

文摘

The hemolytic uremic syndrome (HUS) is related to a thrombotic microangiopathy in the kidney, leading to hypertension and acute renal failure. In the post-infectious, typical form, its pathogenesis includes a lesion/activation of endothelial cells, mainly in the kidney vasculature, induced by bacterial enterotoxins known as the shiga-toxins. Haemolytic anemia with schizocytes, thrombocytopenia without intravascular coagulation and renal failure are present. In typical HUS, a prodromic hemorragic diarrhea is observed due to an infection by an enteropathogenic bacteria, mainly the O157:H7 Escherichia coli. Recently a very large epidemic of diarrhea complicated by HUS in about 25% of the cases has been observed in Germany. Prognosis has improved greatly, and the patient survival rate is higher than 85% in a year. Chronic renal failure may result in 10 to 20% of the cases. Fresh plasma infusion or plasma exchanges are recommended in most of the cases of typical HUS, especially in severe forms in both children and adults. However, eculizumab, an anti-C5 antibody which is now recommended in complement deficiency-associated HUS, has been shown recently to be effective in post-infectious HUS as well. It may become the firstline treatment of infectious HUS in the near future.