Two cases of hemolytic uremic syndrome

DOI
  • Yoshida Atsuhiro
    The third Department of Internal Medicine, Medical School, Nagoya City University
  • Oikawa Tadashi
    The third Department of Internal Medicine, Medical School, Nagoya City University
  • Shinmura Ikuo
    The third Department of Internal Medicine, Medical School, Nagoya City University
  • Morozumi Kunio
    The third Department of Internal Medicine, Medical School, Nagoya City University
  • Fujinami Takao
    The third Department of Internal Medicine, Medical School, Nagoya City University
  • Yokoi Yoshikazu
    Department of Pediatrics, Nagoya Second Red Cross Hospital
  • Yoshino Masahiro
    Department of Pediatrics, Nagoya Second Red Cross Hospital
  • Katoh Tomoyoshi
    Department of Pediatrics, Nagoya Second Red Cross Hospital
  • Miyai Hironobu
    Deparment of Nephrology, Nagoya Second Red Cross Hospital
  • Sohmiya Shinken
    Deparment of Nephrology, Nagoya Second Red Cross Hospital
  • Gotoh Izumi
    Deparment of Nephrology, Nagoya Second Red Cross Hospital

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Other Title
  • 溶血性尿毒症性症候群の2症例

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Two interesting cases of hemolytic uremic syndrome (HUS) are reported in this paper.<br>The first case was that of a 46-year-old male admitted with nephrotic syndrome and fever elevation in October 1951. A renal biopsy performed on 25 October showed pathological findings of HUS. The serum creatinine (s-Cr) level increased rapidly and progressively.<br>Hemodialysis (HD) was started but was discontinued after 3 weeks, because of recovery from uremia. On 1 December laparotomy was performed because of massive GI bleeding from a duodenal ulcer. After the operation, intraperitoneal bleeding of unknown origin and dilatation of the stomach occurred.<br>In consequence of severe dehydration, the s-Cr level rose again, and the patient was re-introduced to maintenance HD.<br>In this case, we were able to treat the HUS by early introduction to HD, but another factor led the patient to end-stage renal failure.<br>The second case was that of a 13-year-old female admitted with chronic glomerulonephritis in July 1983. Renal biopsy revealed focal and segmental glomerulonephritis (FSGN) with a large crescent. This patient received intensive treatment with cyclophosphamide, urokinase and dipyridamole. On 3 September she complained of fever, and subsequent GI bleeding and decreased renal function were observed.<br>She was introduced to HD, and after 11HD treatments her renal function was improved. However, gradually S-Cr increased again, and hemodialysis was begun again in November.<br>We suggest that the patient with FSGN with a crescent was affected with HUS accidentally. The first, reversible, uremia was due to HUS, and the second, irreversible, uremia resulted from the accelerated course of the FSGN.

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