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.
METHODS: 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.
METHODS: 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.
摘要：
背景：溶血性尿毒综合征（HUS）是儿童急性肾损伤的严重原因。有迹象表明，2019年冠状病毒病(COVID-19)可能是HUS的触发因素。在这项研究中,我们介绍了一例诊断为与COVID-19相关的HUS的儿科病例,该病例进展为终末期肾病.
方法：一名健康的13岁女孩因发烧和呕吐被转诊到我们医院。实验室调查显示Coombs阴性溶血性贫血，血小板减少和肾功能损害伴有COVID-19感染。尽管贫血和血小板减少在入院后第七天表现出改善，肾功能损害持续存在.肾活检的组织病理学发现与HUS和COVID-19均相符。一个月后,患者HUS复发,再次检测COVID-19呈阳性。血浆置换治疗改善肾功能。在COVID-19PCR变为阴性后，Eculizumab治疗重新开始。依库珠单抗未复发贫血和血小板减少症，而肾功能损害持续存在。三个月后，当HUS的遗传分析为阴性时，Eculizumab停用。随后，患者被诊断为终末期肾病.
结论：COVID-19可能与HUS复发有关，导致慢性肾病.进一步的研究应探讨HUS与COVID-19相关的机制。
方法：一名健康的13岁女孩因发烧和呕吐被转诊到我们医院。实验室调查显示Coombs阴性溶血性贫血，血小板减少和肾功能损害伴有COVID-19感染。尽管贫血和血小板减少在入院后第七天表现出改善，肾功能损害持续存在.肾活检的组织病理学发现与HUS和COVID-19均相符。一个月后,患者HUS复发,再次检测COVID-19呈阳性。血浆置换治疗改善肾功能。在COVID-19PCR变为阴性后，Eculizumab治疗重新开始。依库珠单抗未复发贫血和血小板减少症，而肾功能损害持续存在。三个月后，当HUS的遗传分析为阴性时，Eculizumab停用。随后，患者被诊断为终末期肾病.
结论：COVID-19可能与HUS复发有关，导致慢性肾病.进一步的研究应探讨HUS与COVID-19相关的机制。
