A Severe Form of Atypical Hemolytic Uremic Syndrome in a Two-Year-Old Girl: A Case Report.

Hemolytic uremic syndrome (HUS) is a prevalent cause of severe acute kidney injury in children, often leading to chronic renal damage. It is characterized by thrombotic microangiopathy (TMA), which represents a triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment. The choice of treatment and management strategies depends primarily on the underlying etiology. We present the case of a two-year-old girl diagnosed with rapidly progressive glomerulonephritis accompanied by hypertension necessitating renal replacement therapy. Initial laboratory findings indicated positive antinuclear antibodies, prompting immunosuppression and renal biopsy, revealing TMA with minimal chronicity changes. The treatment involved plasmapheresis and a single dose of injection rituximab, resulting in clinical recovery with an improved glomerular filtration rate. Since the anti-complement factor H antibody result was negative, the genetic etiology of atypical HUS was considered. The patient was discharged with favorable outcomes, including normal urine output and the absence of edema. This case concludes that young children with atypical HUS may present with a severe clinical course necessitating early intervention. The lack of genetic analysis facilities in severe cases should not hinder the timely initiation of plasmapheresis to prevent further injury and progression to chronic kidney disease.

A Comparable Study on the Outcomes of Urgent Initiated Peritoneal Dialysis Versus Conventional Start, A Single Centre Study from North-East India.

INTRODUCTION: To avoid temporary hemodialysis, urgent initiated PD (UIPD) has been designed. In these patients, PD is initiated within 3 days after PD catheter placement. In this study, we evaluated the outcomes of UIPD in end-stage renal disease patients compared with the conventional start of PD. METHODS: This is a single-center observational study, comparing outcomes of UIPD to conventional initiation of PD. All patients diagnosed with ESRD from March 2013 to February 2019 and were willing for CAPD were recruited. In UIPD group treatment was initiated at day 2 of catheter insertion with a dialysate volume of 1000 mL per dwell for 2 hours gradually increased to 2000 mL per dwell volume by 8 to 10 days. RESULTS: During the study period, 98 patients were started on peritoneal dialysis in our hospital: 35 UIPD, 63 conventional PD. The mean age was 60.81 ± 13.04 years. 67% of patients were males with diabetes mellitus (32%) being the most common cause of CKD. Among the patients in UIPD, the mean age was 58.49 ± 16.1 years, while as in conventional group mean age was 62.10 ± 10.9 years. The Median follow-up time was 381 days. Technique survival was seen in 95 patients (96.9%). There was no difference in technique failure between UIPD vs conventional group. Total complications in our study occurred in 16 patients out of 98 patients during this period. There was no significant difference in the complication rates between the UIPD group and the conventional group. CONCLUSION: Our study showed that catheter patency, technique survival, and catheter-related complications were comparable between UIPD and conventional start peritoneal dialysis.

Serum Homocysteine, Vitamin B12 and Folic Acid Levels in Patients with Metabolic Syndrome.

OBJECTIVE: To study alterations in and factors affecting blood levels of homocysteine and its related vitamins (B12 and folic acid) in patients with metabolic syndrome. Methods: In this case-control study, conducted in a referral hospital in north India, blood levels of vitamin B12, folic acid and homocysteine were compared and also correlated with anthropometric parameters, blood sugar, lipids (total, LDL and HDL cholesterol) and hematological variables. METHODS: Seventy five subjects (50 patients and 25 controls; mean age 48.6±11.5 years; 57% males) were studied. As compared to controls, patients with metabolic syndrome had higher blood levels of homocysteine (16.77±6.6 vs 6.48±0.87 units; P<0.0001), lower levels of B12 (183.7±37 vs 346.4±74.4 units; P<0.0001) and lower levels of folic acid (3.25±1.9 vs 5.31±0.75 units; P<0.0001). All 3 levels were abnormal in 64% patients and none of controls (P<0.0001). Blood levels of homocysteine, folic acid and vitamin B12 correlated with weight, waist circumference, body mass index, fasting blood sugar and lipid levels. These levels also correlated with hematological parameters (hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration). CONCLUSIONS: Indian patients with metabolic syndrome have a strong association with elevated blood levels of homocysteine and reduced levels of vitamin B12 and folic acid. Further studies are needed to test the hypotheses that these metabolites have a greater role in Asians and there may be a greater beneficial role of folic acid supplementation.