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Síndrome hemolítica-urémica : casuística de uma unidade de cuidados intensivos pediátricos
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A Síndrome Hemolítica-Urémica (SHU) é uma entidade patológica ainda não completamente conhecida, que atualmente lidera a lista das causas de falência renal aguda em idade pediátrica. Para além de ser uma doença rara, pode associar-se a um prognóstico renal reservado e a taxas de mortalidade/morbilidade não desprezíveis, pelo que o seu reconhecimento deve ser precoce e a abordagem sistematizada, sendo por vezes necessário internamento numa Unidade de Cuidados Intensivos. Neste estudo foram analisados os casos de SHU admitidos na Unidade de Cuidados Intensivos Pediátricos do Hospital de Santa Maria (UCIPed), entre 2005 e 2014, quanto à apresentação, evolução clínica e laboratorial, suporte terapêutico, complicações, prognóstico e mortalidade. Foram englobadas 13 crianças. A duração do internamento na UCIPed teve uma mediana de 7 dias, e o internamento hospitalar teve uma mediana de 17 dias. Em 38% dos doentes (n=5) foram utilizadas técnicas de substituição renal (TSR). Durante o internamento ocorreram complicações infeciosas (n=5), neurológicas (n=2) e hemorrágicas (n=1). Um doente faleceu por agravamento do quadro neurológico. Dois doentes necessitaram de reinternamento por agravamento clínico e/ou laboratorial. No seguimento (n=11), um doente necessitou de transplante, em 4 doentes verificou-se hipertensão arterial, e 6 doentes não tiveram quaisquer alterações clínicas e/ou laboratoriais até à data.
The hemolytic-uremic syndrome (HUS) is a not yet fully understood pathological entity that currently stands as the leading cause for acute kidney injury in childhood. Besides being a rare disease, HUS might be associated with adverse renal prognosis and non-dismissible mortality/morbidity rates, whereby an early detection and a standardized approach are critical. Moreover, commitment into a Pediatric ICU is sometimes deemed necessary. Throughout the present study, records of HUS cases admitted to the Pediatric Intensive Care Unit (PICU) in Hospital de Santa Maria, dating from 2005 to 2014 were analyzed in terms of presentation and clinical and laboratorial evolution, therapeutic support, complications, prognosis and mortality. Thirteen children were included. PICU hospitalization had a median value of 7 days and the total hospitalization period had a median duration of 17 days. Dialysis techniques were necessary in 38% of the patients (n=5). During hospitalization infectious (n=5), neurological (n=2) and hemorrhagic (n=1) complications arose. One patient died due to neurological complications. Two patients were readmitted for clinical and/or laboratorial aggravation. On follow-up (n=11), one patient needed transplantation, 4 patients developed arterial hypertension, and 6 patients haven’t shown any noticeable changes to date.
The hemolytic-uremic syndrome (HUS) is a not yet fully understood pathological entity that currently stands as the leading cause for acute kidney injury in childhood. Besides being a rare disease, HUS might be associated with adverse renal prognosis and non-dismissible mortality/morbidity rates, whereby an early detection and a standardized approach are critical. Moreover, commitment into a Pediatric ICU is sometimes deemed necessary. Throughout the present study, records of HUS cases admitted to the Pediatric Intensive Care Unit (PICU) in Hospital de Santa Maria, dating from 2005 to 2014 were analyzed in terms of presentation and clinical and laboratorial evolution, therapeutic support, complications, prognosis and mortality. Thirteen children were included. PICU hospitalization had a median value of 7 days and the total hospitalization period had a median duration of 17 days. Dialysis techniques were necessary in 38% of the patients (n=5). During hospitalization infectious (n=5), neurological (n=2) and hemorrhagic (n=1) complications arose. One patient died due to neurological complications. Two patients were readmitted for clinical and/or laboratorial aggravation. On follow-up (n=11), one patient needed transplantation, 4 patients developed arterial hypertension, and 6 patients haven’t shown any noticeable changes to date.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Síndrome hemolítica-urémica Rim Nefropatias Pediatria