Abstract

Background. Hemolytic uremic syndrome (HUS) is a serious cause of acute kidney injury in children. There is a suggestion that coronavirus disease 2019 (COVID-19) may be a trigger for HUS. In this study, we present a pediatric case diagnosed with HUS associated with COVID-19, which progressed to end-stage kidney disease.

Case. A previously healthy 13-year-old girl with fever and vomiting was referred to our hospital. Laboratory investigations revealed direct Coombs-negative hemolytic anemia, thrombocytopenia and renal impairment accompanied by COVID-19 infection. Although anemia and thrombocytopenia showed improvement on the seventh day after admission, the renal impairment persisted. The histopathological findings of a renal biopsy were compatible with both HUS and COVID-19. One month later, the patient had a recurrence of HUS, again testing positive for COVID-19. Kidney function improved with plasma exchange therapy. Eculizumab treatment was recommenced after COVID-19 PCR became negative. Anemia and thrombocytopenia did not recur with eculizumab, while renal impairment persisted. Eculizumab was discontinued after three months when genetic analysis for HUS was negative. Subsequently, the patient was diagnosed with end-stage kidney disease.

Conclusions. COVID-19 can be associated with HUS relapses, leading to chronic kidney disease. Further studies should investigate the mechanism of HUS associated with COVID-19.

Keywords: COVID-19, chronic kidney disease, hemolytic uremic syndrome, SARS-CoV-2

How to cite

1.
Sürmeli Döven S, Danacı Vatansever E, Yuyucu Karabulut Y, Özgökçe Özmen B, Durak F, Delibaş A. A pediatric case with hemolytic uremic syndrome associated with COVID-19, which progressed to end-stage kidney disease. Turk J Pediatr 2024; 66: 251-256. https://doi.org/10.24953/turkjpediatr.2024.4524

References

  1. Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020; 46: 1089-1098. https://doi.org/10.1007/s00134-020-06062-x
  2. Kurian CJ, French Z, Kukulich P, et al. Case series: coronavirus disease 2019 infection as a precipitant of atypical hemolytic uremic syndrome: two case reports. J Med Case Rep 2021; 15: 587. https://doi.org/10.1186/s13256-021-03144-2
  3. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395: 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5
  4. Yu J, Yuan X, Chen H, Chaturvedi S, Braunstein EM, Brodsky RA. Direct activation of the alternative complement pathway by SARS-CoV-2 spike proteins is blocked by factor D inhibition. Blood 2020; 136: 2080-2089. https://doi.org/10.1182/blood.2020008248
  5. Trimarchi H, Gianserra R, Lampo M, Monkowski M, Lodolo J. Eculizumab, SARS-CoV-2 and atypical hemolytic uremic syndrome. Clin Kidney J 2020; 13: 739-741. https://doi.org/10.1093/ckj/sfaa166
  6. Mahajan R, Lipton M, Broglie L, Jain NG, Uy NS. Eculizumab treatment for renal failure in a pediatric patient with COVID-19. J Nephrol 2020; 33: 1373-1376. https://doi.org/10.1007/s40620-020-00858-2
  7. Raina R, Vijayvargiya N, Khooblall A, et al. Pediatric atypical hemolytic uremic syndrome advances. Cells 2021; 10: 3580. https://doi.org/10.3390/cells10123580
  8. Conway EM, Pryzdial ELG. Is the COVID-19 thrombotic catastrophe complement-connected? J Thromb Haemost 2020; 18: 2812-2822. https://doi.org/10.1111/jth.15050
  9. Gill J, Hebert CA, Colbert GB. COVID-19-associated atypical hemolytic uremic syndrome and use of Eculizumab therapy. J Nephrol 2022; 35: 317-321. https://doi.org/10.1007/s40620-021-01125-8
  10. Malgaj Vrečko M, Aleš Rigler A, Večerić-Haler Ž. Coronavirus Disease 2019-associated thrombotic microangiopathy: literature review. Int J Mol Sci 2022; 23: 11307. https://doi.org/10.3390/ijms231911307
  11. Dalkıran T, Kandur Y, Kara EM, Dağoğlu B, Taner S, Öncü D. Thrombotic microangiopathy in a severe pediatric case of COVID-19. Clin Med Insights Pediatr 2021; 15: 11795565211049897. https://doi.org/10.1177/11795565211049897
  12. Nomura E, Finn LS, Bauer A, et al. Pathology findings in pediatric patients with COVID-19 and kidney dysfunction. Pediatr Nephrol 2022; 37: 2375-2381. https://doi.org/10.1007/s00467-022-05457-w
  13. Alizadeh F, O’Halloran A, Alghamdi A, et al. Toddler with new onset diabetes and atypical hemolytic-uremic syndrome in the setting of COVID-19. Pediatrics 2021; 147: e2020016774. https://doi.org/10.1542/peds.2020-016774
  14. Nishimura JI, Yamamoto M, Hayashi S, et al. Genetic variants in C5 and poor response to eculizumab. N Engl J Med 2014; 370: 632-639. https://doi.org/10.1056/NEJMoa1311084