SUCCESFULLY TREATED HEMOLITIC UREMIC SYNDROME (HUS) BY PLASMA APHERESIS AFTER KIDNEY TRANSPLANTATION

Abstract

Objectives: The HUS is a rare disease; it exists a kind related to acute toxicity by Cyclosporine on the short time following kidney transplantation. Although the causes of this syndrome are still unclear, data from the literature show that patients with high levels of Reactive Antibodies (PRA test), Alport syndrome (as primitive renal disease), or which have history of HUS present a higher risk of HUS after renal transplantation. Materials and Methods: We report a case of a 58 yr old woman whose cause of uremia we did not know dependent on an episode of HUS. The patients underwent renal transplantation from deceased donor and treated with Cyclosporine, Mycophenolate Mofetil and steroids as immunosuppressant therapy. The graft function started immediately after transplantation and the patient was discharged on 15th day. After 30 days from transplantation it appeared hemolitic anemia, thrombocytopenia, high levels of indirect bilirubin and LDH, and worsening of renal function. The clinical picture and renal biopsy showed the pattern of thrombotic microangiopaty; therefore the patient underwent 10 plasmapheresis sessions lasting 4 hours each. Results: We observed a dramatic improvement of clinical status and renal function. The patients was discharged with a complete remission of HUS and a well functioning graft. Conclusions: Plasmapheresis, as reported from the literature, reduces mortality in case of HUS after kidney transplantation from 100 to 15%, with improvement of graft function up to 80%. The case we depicted confirms as prognosis can be improved if diagnosis is done early and patient sent to plasmapheresis sessions as soon as possible.