Pediatric Nephrology

, Volume 3, Issue 2, pp 130–134 | Cite as

The polymorphonuclear leucocyte count in childhood haemolytic uraemic syndrome

  • Martin D. S. Walters
  • I. Ute Matthei
  • Richard Kay
  • Michael J. Dillon
  • T. Martin Barratt
Original Article

Abstract

Review of data from 79 children with the haemolytic uraemic syndrome (HUS) showed that the polymorphonuclear leucocyte (PMN) count at presentation in childhood HUS predicts outcome. Logistic regression analysis of several features at presentation identified only the PMN count and the presence of a diarrhoeal prodrome as having a significant effect on the outcome (P<0.01 andP<0.001 respectively). The geometric mean PMN count was significantly raised in 70 children who had typical HUS following a diarrhoeal prodrome (D+cases) compared with that of 9 children who had atypical disease without diarrhoea (D-cases) (t-test on log-transformed data,P<0.005). Fifty-seven children with D+HUS who recovered completely had a significantly lower geometric mean PMN count than D+cases with a bad outcome (P<0.001). Four of these patients, who died in the acute stage of the disease, had a significantly higher mean count than the rest of the D+patients (P<0.001). Multiple regression analysis demonstrated that the PMN count in D+cases was not significantly influenced by haemoglobin concentration, platelet count, length of the prodrome, or the administration of antibiotics in the prodromal period. A high PMN count at presentation in D+HUS indicates a poor prognosis. The data emphasise the heterogeneity of HUS and suggest that PMN participate in the pathogenesis of the disorder in typical D + cases but not in atypical D- cases.

Key words

Haemolytic uraemic syndrome Polymorphonuclear leucocyte count 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Levin M, Barratt TM (1984) Haemolytic uraemic syndrome. Arch Dis Child 1984: 59:397–400Google Scholar
  2. 2.
    Anderson JA (1980) Logistic discrimination. In: Krishnaiah PR (ed) Handbook of statistics, vol 2. North Holland, New YorkGoogle Scholar
  3. 3.
    Kaplan BS, Chesney RW, Drummond KN (1975) Hemolytic uremic syndrome in families. N Engl J Med 292: 1090–1093PubMedGoogle Scholar
  4. 4.
    Trompeter RS, Schwartz R, Chantler C, Dillon MJ, Haycock GB, Kay R, Barratt TM (1983) Haemolytic uraemic syndrome: an analysis of prognostic features. Arch Dis Child 58:101–105PubMedGoogle Scholar
  5. 5.
    Dolisager D, Tune B (1978) The hemolytic uremic syndrome: spectrum of severity and significance of prodrome. Am J Dis Child 132:55–58PubMedGoogle Scholar
  6. 6.
    Habib R, Levy M, Gadnadoux M, Broyer M (1982) Prognosis of the hemolytic uremic syndrome in children. In: Hamburger J (ed) Proceedings of the Necker Hospital. Year Book Medical, Chicago, pp 99–127Google Scholar
  7. 7.
    Levin M, Stroobant P, Walters MDS, Cheng DJ, Waterfield MD, Barratt TM (1986) Platelet-derived growth factors are possible mediators of vascular proliferation in the sporadic haemolytic uraemic syndrome. Lancet II: 830–833Google Scholar
  8. 8.
    Kamali MA, Steele BT, Petric M, Lim C (1983) Sporadic cases of haemolytic uraemic syndrome associated with faecal cytotoxin and cytotoxin-producingEscherichia coli in stools. Lancet I:619–620Google Scholar
  9. 9.
    Wells JG, Davis BR, Wachsmith IK, Riley LW, Remis RS, Sokolow R, Morris GK (1983) Laboratory investigation of hemorrhagic colitis outbreaks associated with a rareEscherichia coli serotype. J Clin Microbiol 18: 512–520PubMedGoogle Scholar
  10. 10.
    Harlan JM, Killen PD, Harker LA, Striker GE (1981) Neutrophil-mediated endothelial injury in vitro. J Clin Invest 68:1394–1403PubMedGoogle Scholar
  11. 11.
    Smedly LA, Tonnesen MG, Sandhaus RA, Haslet C, Guthrie LA, Johnson PM, Henson PM, Worthen GS (1986) Neutrophil-mediated injury to endothelial cells. J Clin Invest 77:1233–1243PubMedGoogle Scholar
  12. 12.
    Vedanarayanan VV, Kaplan BS, Fong JSC (1987) Neutrophil function in an experimental model of hemolytic uremic syndrome. Pediatr Res 21:252–256PubMedGoogle Scholar
  13. 13.
    Sacks T, Moldow CF, Craddock PR, Bowers TK, Jacob HS (1978) Oxygen radicals mediate endothelial cell damage by complement stimulated granulocytes. J Clin Invest 61:1161–1167PubMedGoogle Scholar
  14. 14.
    Weiss SJ, Young J, LoBuglio AF, Slivka A, Nimeh NF (1981) Role of hydrogen peroxide in neutrophil-mediated destruction of cultured endothelial cells. J Clin Invest 68: 714–721PubMedGoogle Scholar
  15. 15.
    Shingu M, Yoshioka K, Nobunaga M, Yoshida K (1985) Human vascular smooth muscle cells and endothelial cells lack catalase activity and are susceptible to hydrogen peroxide. Inflammation 9:309–320PubMedGoogle Scholar
  16. 16.
    O'Regan S, Chesney RW, Kaplan BS, Drummond KN (1980) Red cell membrane phospholipid abnormalities in the hemolytic uremic syndrome. Clin Nephrol 15:14–17Google Scholar
  17. 17.
    Powell HR, Groves V, McCredie DA, Yong A, Pitt J (1987) Low red cell arachidonic acid in hemolytic uremic syndrome. Clin Nephrol 27:8–10PubMedGoogle Scholar
  18. 18.
    Butler T, Islam MR, Azad MAK, Jones PK (1987) Risk factors for the development of hemolytic uremic syndrome during shigellosis. J Pediatr 110:894–897PubMedGoogle Scholar
  19. 19.
    Koster F, Levin J, Walker L, Tung KSK, Gilman RH, Rahaman MM, Majid UA, Islam S, Williams RC (1978) Hemolytic uremic syndrome after shigellosis: relation to endotoxemia and circulating immune complexes. N Engl J Med 298:927–933PubMedGoogle Scholar
  20. 20.
    Baker NM, Mills AE, Rachman I, Thomas JEP (1974) Haemolytic uraemic syndrome in typhoid fever. Br Med J 2:84–87PubMedGoogle Scholar
  21. 21.
    Prober CG, Tune B, Holder L (1979)Yersinia pseudotuberculosis septicemia. Am J Dis Child 133:623–624PubMedGoogle Scholar
  22. 22.
    Ray CG, Tucker VL, Harris DJ (1970) Enteroviruses associated with the hemolytic uremic syndrome. Pediatrics 46:378–388PubMedGoogle Scholar
  23. 23.
    Chamovitz BN, Alan I, Hartstein AI, Alexander SR, Terry AB, Short P, Katon R (1983)Campylobacter jejuni associated hemolytic uremic syndrome in a mother and daughter. Pediatrics 71:253–256PubMedGoogle Scholar

Copyright information

© IPNA 1989

Authors and Affiliations

  • Martin D. S. Walters
    • 1
    • 2
  • I. Ute Matthei
    • 1
    • 2
  • Richard Kay
    • 3
  • Michael J. Dillon
    • 1
    • 2
  • T. Martin Barratt
    • 1
    • 2
  1. 1.Department of Paediatric NephrologyInstitute of Child HealthLondonUK
  2. 2.Renal UnitHospital for Sick ChildrenLondonUK
  3. 3.Department of Probability and StatisticsUniversity of SheffieldSheffieldUK

Personalised recommendations