Diagnosis and Management of Atypical Hemolytic Uremic Syndrome In Children: Single Centre Experience

  • Rashmi D. Patel
  • Aruna V. Vanikar
  • Manoj R. Gumber
  • Kamal V. Kanodia
  • Kamlesh S. Suthar
  • Himanshu V. Patel
  • Hargovind L. Trivedi
Original Article


Atypical hemolytic uremic syndrome (aHUS) although rare is the commonest cause of acute renal failure (ARF) in children and has poor prognosis. We present single centre experience of aHUS. Thirty six children (29 males, 7 females) with mean age, 7.9 years presented with ARF, 2 children also had tonic–clonic type convulsions. Their hematology examination revealed hemolytic anemia with s. creatinine (SCr), 5.54 mg/dl. Acute HUS was observed in 75 %, acute on chronic HUS in 19.4 % and patchy cortical necrosis (PCN) in 5.6 % biopsies. Mean 5.4 plasma exchanges (PE) were carried out. Supportive management of anti-hypertensives and prednisone was also given. Recovery end points were establishment of urine output, improvement of SCr and hematological profile. Hematology and renal function profile improved variably in all children, 5.6 % died, relapse was observed in 80.5 % over mean 70 days; 13.9 % children are doing well over mean follow-up of 268.8 days. Thus poor prognosis was observed in 86.1 % children. Children with acute on chronic HUS and PCN did not recover. Six children who recovered had acute HUS. aHUS in Indian children occurs at an older age of around 8 years and chronic/irreversible changes on histopathology examination are harbingers of poor prognosis. PE is life-saving however further research for developing strategies to improve long-term survival is needed.


Hemolytic uremic syndrome Thrombotic thrombocytopenic purpura Plasma exchange Microangiopathic hemolytic anemia 



Acute renal failure


Atypical hemolytic uremic syndrome


Continuous ambulatory peritoneal dialysis


Complete blood counts


Chronic renal failure


Fresh frozen plasma




Hemolytic uremic syndrome




Lactic dehydrogenase


Microangiopathic hemolytic anemia


Plasma exchange


Serum creatinine


Total leucocyte count


Von Willebrand factor


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Copyright information

© Indian Society of Haematology & Transfusion Medicine 2013

Authors and Affiliations

  • Rashmi D. Patel
    • 1
  • Aruna V. Vanikar
    • 1
  • Manoj R. Gumber
    • 2
  • Kamal V. Kanodia
    • 1
  • Kamlesh S. Suthar
    • 1
  • Himanshu V. Patel
    • 2
  • Hargovind L. Trivedi
    • 2
  1. 1.Department of Pathology, Laboratory Medicine and Transfusion Services and ImmunohematologyG. R. Doshi and K. M. Mehta Institute Of Kidney Diseases and Research Centre (IKDRC)-Dr. H.L. Trivedi Institute Of Transplantation Sciences (ITS)Asarwa, AhmedabadIndia
  2. 2.Department of Nephrology and Transplantation MedicineG. R. Doshi and K. M. Mehta Institute Of Kidney Diseases and Research Centre (IKDRC)-Dr. H.L. Trivedi Institute Of Transplantation Sciences (ITS)Asarwa, AhmedabadIndia

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