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Uremic Anemia


Presentation

  • Conclusion: Our patient had an unusual presentation of Hemolytic uremic syndrome characterized by severe thrombocytopenia and hemolytic anemia.[bloodjournal.org]
  • Some results obtained on real data are presented.[ncbi.nlm.nih.gov]
  • In this report, we describe a case of microangiopathic hemolytic anemia following myxoma excision and mitral valve repair, which was presented as hemolytic uremic syndrome.[synapse.koreamed.org]
  • Since LC deficiency is commonly present in dialysis patients, LC has been described as a "conditional vitamin". However, the use of LC supplementation in dialysis remains controversial as well as its mode of action in preventing anemia.[wrap.warwick.ac.uk]
  • Therefore, a high index of suspicion should be maintained on initial presentation.[clinicaladvisor.com]
Anemia
  • Though both pHRE-Epo and pCMV-Epo corrected anemia, the hematocrit of the pCMV-Epo-treated rats exceeded the normal (P 0.05), but that of the pHRE-Epo-treated rats didn't.[ncbi.nlm.nih.gov]
  • Adjuvant therapies for renal anemia include the naturally occurring compound L-carnitine. Here, we here review the evidence available for L-carnitine treatment in dialysis patients suffering from uremic anemia.[wageningenacademic.com]
  • It seems that an upper respiratory infection caused both autoimmune hemolytic anemia (AIHA) and aHUS in our patient.[caspianjp.ir]
Pallor
  • Excoriations (uremic pruritus), pallor (anemia), muscle wasting, and a nitrogenous fetor are all signs of advanced CKD, as are pericarditis, pleuritis, and asterixis, complications of particular concern that usually prompt the initiation of dialysis.[accessmedicine.mhmedical.com]
  • […] factors use of antimotility agents in EHEC diarrhea use of antibiotics in EHEC diarrhea Presentation Symptoms prodromal gastrointestinal illness abdominal pain bloody diarrhea nausea vomiting fatigue (anemia) oliguria/anuria (renal failure) Physical exam pallor[medbullets.com]
  • Following the prodrome, there is a sudden onset of pallor, irritability, weakness and lethargy. Petechaie and purpura are uncommon features of HUS and severe bleeding is extremely rare (1).[hawaii.edu]
  • Symptoms Signs and symptoms of HUS can include: Bloody diarrhea Decreased urination or blood in the urine Abdominal pain, vomiting and occasionally fever Pallor Small, unexplained bruises or bleeding from the nose and mouth Fatigue and irritability Confusion[mayoclinic.org]
  • CLINICAL FEATURES The commonest clinical presentation of HUS is :  Acute pallor  Oliguria  Diarrhea or dysentery It occurs commonly in children between 1-5 years of age HUS develops about 5-10 days after onset of diarrhea 14.[slideshare.net]
Chronic Infection
  • It has been described that patients with CKD have a higher risk of certain types of cancer due to dysfunction of the immune system, inadequate DNA repair, reduction of antioxidant defense, accumulation of carcinogens, chronic infections and inflammation[revistanefrologia.com]
  • infections and myeloproliferative diseases.[aafp.org]
  • Criteria of exclusion were the presence of acute or chronic infection, active immunological disease, and blood transfusion with-in the past month. Healthy subjects, defined after clinical interview were recruited from laboratory staff.[mdpi.com]
Collapse
  • The hemolytic anemia is type as evidenced by the collapse of haptoglobin and elevation of LDH [ 4 ].[em-consulte.com]
  • She underwent a kidney biopsy which showed diffuse, thrombotic microangiopathy involving all glomeruli, arterioles, and focal small arteries of a severe nature; global collapsing glomerulopathy; and diffuse acute tubular injury ( Figure 1 ).[pubs.sciepub.com]
Regurgitation
Epigastric Tenderness
  • Her exam was remarkable for mild scleral icterus, epigastric tenderness but no peritoneal signs. Her labs showed renal failure; BUN 90mg/dl, Cr 4.69 mg/dl, anemia: hemoglobin of 8.4g/dl and severe thrombocytopenia with a platelet count of 4,000/uL.[bloodjournal.org]
Scleral Icterus
  • Her exam was remarkable for mild scleral icterus, epigastric tenderness but no peritoneal signs. Her labs showed renal failure; BUN 90mg/dl, Cr 4.69 mg/dl, anemia: hemoglobin of 8.4g/dl and severe thrombocytopenia with a platelet count of 4,000/uL.[bloodjournal.org]
  • Upon presentation, she was in fact noted to have scleral icterus and mild epigastric abdominal tenderness.[pubs.sciepub.com]
Tachycardia
  • His heart has a regular rhythm with tachycardia and a grade II/VI vibratory systolic ejection murmur at the left sternal border without radiation. No heaves, lifts, thrills, rubs, or gallops are present. His lungs are clear with good aeration.[hawaii.edu]

Workup

  • The family history is paramount in the workup of autosomal dominant polycystic kidney disease or hereditary nephritis (Alport’s syndrome).[accessmedicine.mhmedical.com]
  • Diagnostic Workup for Hemolytic-Uremic Syndrome Laboratory investigations are helpful in the evaluation of the HUS patient. Urine analysis confirms acute renal injury as proteinuria and hematuria are common.[lecturio.com]
  • After failing to respond to plasmapharesis and with normal ADAMTS13 levels, she was started on eculizumab therapy while more workup was performed.[pubs.sciepub.com]
  • […] and lead to an increase in the levels of free radicals, thus introducing cell damage, increased platelet aggregation, increased binding of tissue plasminogen activator in the endothelium, and increased expression of local procoagulant factors. 47 Lab workup[scielo.br]
Normocytic Normochromic Anemia
  • A blood smear exam showed mild normocytic normochromic anemia with anisocytosis and polychromasia.[synapse.koreamed.org]
  • , normochromic anemia Urinalysis : : possibly abnormal urine sediment ( see nephritic sediment, nephrotic sediment ) Ultrasound : shrunken kidneys and fibrotic parenchyma Renal biopsy : sometimes indicated to determine the underlying cause In chronic[amboss.com]
  • Biochemistry revealed: normocytic normochromic anemia (Hb 6 g/dL); platelet count 132 10 9 L 1, acute kidney injury (Urea 81 mmol/L; Creatinine 1487 μmol/L); high Lactate dehydrogenase (LDH 23 μkat/L) and proteinuria (100 mg/dL).[medintensiva.org]
Normocytic Normochromic Anemia
  • A blood smear exam showed mild normocytic normochromic anemia with anisocytosis and polychromasia.[synapse.koreamed.org]
  • , normochromic anemia Urinalysis : : possibly abnormal urine sediment ( see nephritic sediment, nephrotic sediment ) Ultrasound : shrunken kidneys and fibrotic parenchyma Renal biopsy : sometimes indicated to determine the underlying cause In chronic[amboss.com]
  • Biochemistry revealed: normocytic normochromic anemia (Hb 6 g/dL); platelet count 132 10 9 L 1, acute kidney injury (Urea 81 mmol/L; Creatinine 1487 μmol/L); high Lactate dehydrogenase (LDH 23 μkat/L) and proteinuria (100 mg/dL).[medintensiva.org]
Anisocytosis
  • A blood smear exam showed mild normocytic normochromic anemia with anisocytosis and polychromasia.[synapse.koreamed.org]
  • […] blood chemistry showed the following results: lactate dehydrogenase (LDH), 22.3 μ kat/L; serum total protein, 52 g/L; serum albumin, 33 g/L, calcium, 2.00 mmol/L, phosphorus, 2.19 mmol/L, total bilirubin, 11.9 μ mol/L; peripheral blood smear showed anisocytosis[kjim.org]
  • Most published algorithms for the diagnosis of normocytic anemia begin with an examination of the peripheral blood smear 20 or a corrected reticulocyte index. 2, 9, 21 The red blood cell distribution width is a measure of the variability of the size (anisocytosis[aafp.org]
Hematocrit Increased
  • RESULTS: (1)Three months and one year after operation,hemoglobin,hematocrit increased and erythropoietin average usage decreased significantly (P 0.01) (2) Compared with preoperative period, the dry weight was significantly increased one year after operation[academic.oup.com]
  • Abstract Ferrokinetic studies were performed with 59 Fe-citrate to evaluate erythropoietic activity in CAPD patients and to investigate the mechanism(s) by which the hematocrit increases in CAPD patients.[kjim.org]
Hemoglobin Increased
  • Laboratory parameters improved with hemoglobin, increased platelet count, reduction in urea, creatinine, and total bilirubin level.[ijccm.org]
  • As expected, hematocrit and hemoglobin increased after intravenous iron and α-darbepoetin treatments. However, none of the treatments modified plasma concentrations of iron, ferritin, or transferrin or transferrin saturation.[jasn.asnjournals.org]
Ventricular Hypertrophy
  • CONCLUSIONS: PTX with forearm autograft is an effective treatment for uremic patients with SHPT, can significantly ameliorate anemia and the structure of the left ventricular function, especially for patients with ventricular hypertrophy in preoperative[academic.oup.com]
  • Anemia in CKD patients contributes to many of the symptoms associated with the disease, including fatigue, depression, reduced tolerance of exercise, dyspnea, cardiovascular consequences such as left ventricular hypertrophy and left ventricular systolic[wageningenacademic.com]
  • Furthermore, treatment of anemia with erythropoietin has been shown to produce regression of left ventricular hypertrophy in patients with CKD ( 16 ).[jasn.asnjournals.org]
  • Left ventricular hypertrophy is associated with increased ventricular thickness, arterial stiffening, coronary atherosclerosis, and/or coronary artery calcification.[emedicine.medscape.com]

Treatment

  • Each cycle consisted of three weekly treatments (j1 to j8, j15 1000 mg/m 2 ) followed by a week of rest.[em-consulte.com]
  • Abstract This paper describes how Bayesian networks can be used in combination with compartmental models to plan recombinant human erythropoietin delivery in the treatment of anemia of chronic uremic patients.[ncbi.nlm.nih.gov]
  • On-Line hemodiafiltration as routine treatment of en-stage renal failure: why pre- or mixed dilution mode is necessary in on-line hemodiafiltration today? Blood Purif 2004 ; 22(Suppl 2): S40 – 8 . Google Scholar Crossref 9.[journals.sagepub.com]
  • Here, we here review the evidence available for L-carnitine treatment in dialysis patients suffering from uremic anemia.[wageningenacademic.com]
  • CONCLUSIONS: PTX with forearm autograft is an effective treatment for uremic patients with SHPT, can significantly ameliorate anemia and the structure of the left ventricular function, especially for patients with ventricular hypertrophy in preoperative[academic.oup.com]

Prognosis

  • Conclusions: Since the atypical hemolytic–uremic syndrome has a poor prognosis, its death rates is as high as 25% and it progresses to end-stage renal disease in half of the patients.[caspianjp.ir]
  • The long-term prognosis is related to the underlying malignancy [ 1 ]. Our patient’s course of the syndrome was a favorable change after chemotherapy and blood transfusion.[em-consulte.com]
  • The prognosis is poor, recurrences are frequent, and the mortality rate is 60-70%. Autosomal dominant HUS often occurs in adults, who have a poor prognosis. The risk of death or ESRD is 50-90%.[emedicine.medscape.com]
  • Diagnosis - Atypical hemolytic uremic syndrome Prognosis - Atypical hemolytic uremic syndrome Treatment - Atypical hemolytic uremic syndrome Resources - Atypical hemolytic uremic syndrome[checkorphan.org]

Etiology

  • It involves several etiologies [ 2 ] with infections, connective tissue disease, some treatment (quinine, interferon, clopidogrel, etc.) and cancers.[em-consulte.com]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • In general, kidneys that have shrunk ( Once chronicity has been established, clues from the physical examination, laboratory panel, and urine sediment evaluation can be used to determine etiology.[accessmedicine.mhmedical.com]
  • Our case experienced MAHA associated with outstandingly elevated LDH level and the presence of schistocytes occurring 3 weeks after mitral valve repair and was suspected as HUS because other etiology of acute kidney injury were excluded.[synapse.koreamed.org]
  • Based on the absence of a previous infectious condition and any signs of rejection in the endocardial biopsy that could be triggers, and given the recent introduction of sirolimus, the latter was considered the etiological factor, with blood levels within[revespcardiol.org]

Epidemiology

  • References: [2] [3] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • First, the stx loss in an EHEC strain during infection can mislead epidemiological investigations because an stx -negative strain would not be, based on currently used criteria, considered to be epidemiologically related to stx -positive strains, even[journals.plos.org]
  • Epidemiology HUS has been characterized as either epidemic/endemic (or prodromal) or sporadic (nonprodromal).[pedsinreview.aappublications.org]
  • Addresses the full range of renal problems, from epidemiology to monitoring and diagnostic procedures to pathophysiology of organ systems in relation to kidney failure.[books.google.ro]
  • References References Further Reading Hemolytic Uremic Syndrome (HUS) - Renal Disease Hemolytic Uremic Syndrome: Management and Complications Hemolytic Uremic Syndrome Prevention Hemolytic Uremic Syndrome Epidemiology Hemolytic Uremic Syndrome in Children[news-medical.net]
Sex distribution
Age distribution

Pathophysiology

  • This has led to greater understanding of the pathophysiological factors regulating hematopoiesis. This in turn, hasprompted the search for new therapeutic approaches.[ncbi.nlm.nih.gov]
  • Endothelial cell dysfunction, probably because of the effects of complement activation, is an intermediate stage in the pathophysiologic cascade. Atypical HUS has a grave prognosis.[journals.lww.com]
  • Addresses the full range of renal problems, from epidemiology to monitoring and diagnostic procedures to pathophysiology of organ systems in relation to kidney failure.[books.google.ro]
  • […] of Hemolytic-Uremic Syndrome The most important pathogenic step in the pathophysiology of HUS is the formation of microthrombi within the arterioles and capillaries.[lecturio.com]

Prevention

  • Moreover, EPO and its receptors have been found in the brain, suggesting a role in preventing neuronal death.[ncbi.nlm.nih.gov]
  • However, the use of LC supplementation in dialysis remains controversial as well as its mode of action in preventing anemia. Recent literature shows that to fully exploit its pharmacological potential.[wrap.warwick.ac.uk]
  • […] prophylactic plasma exchange have been used to prevent posttransplant recurrences.[checkorphan.org]
  • , and Complications Prognosis 3-5% mortality 5% severe sequelae such as end-stage renal failure Prevention prevent EHEC infection avoid raw or undercooked meat avoid antimotility agents or antibiotics Complications chronic kidney disease hypertension[medbullets.com]
  • How can HUS be prevented? Preventing infection by bacteria, especially E. coli O157:H7, is key to preventing HUS. The following measures can help prevent infection with E. coli O157:H7: Never eat rare or undercooked ground beef.[vdh.virginia.gov]

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