Recurrent hemolytic uremic syndrome in an adult renal allograft recipient: Current concepts and management

Anupam Agarwal, S. Michael Mauer, Arthur J. Matas, Karl A. Nath

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Acute renal insufficiency in the setting of hemolysis and thrombocytopenia, a triad that constitutes adult or pediatric hemolytic uremic syndrome, can be associated with or triggered by diverse conditions such as verocytotoxin-producing Escherichia coli, viral infections, pregnancy, malignant hypertension, scleroderma, renal radiation, allograft rejection, lupus erythematosus, and assorted medications such as mitomycin C, cyclosporine, and oral contraceptives. Recurrent and de novo hemolytic uremic syndrome occur after renal transplantation. Relapses are also common and probably reflect incomplete resolution of the initial episode. The major differential diagnoses of hemolytic uremic syndrome in the renal allograft include acute vascular rejection, cyclosporine, FK506 or antilymphocyte antibody nephrotoxicity, and malignant hypertension, all of which may display overlapping clinical and histologic features with primary hemolytic uremic syndrome; in such instances, the exact diagnosis may be quite difficult. It is possible that the risk of recurrence may be reduced by proper timing of transplantation and suitable choice of immunosuppressive agents. Intensive plasmapheresis in conjunction with fresh frozen plasma and supportive management of renal failure may lessen mortality and morbidity even in recurrent hemolytic uremic syndrome after transplantation.

Original languageEnglish (US)
Pages (from-to)1160-1169
Number of pages10
JournalJournal of the American Society of Nephrology
Volume6
Issue number4
StatePublished - Oct 1 1995

Keywords

  • Acute rejection
  • Cyclosporine
  • Plasmapheresis
  • Renal transplantation

ASJC Scopus subject areas

  • Nephrology

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