RESUMEN
Posterior reversible encephalopathy syndrome (PRES) is a clinical and neuroimaging syndrome that can affect both children and adults and has variable etiology. It is clinically defined by headaches, consciousness disorders, seizures and visual disturbances. Early recognition (clinical and imaging) can lead to appropriate general measures to correct the underlying cause of PRES. In this paper, we report a case of PRES in an eight-year-old boy with bilateral renal hypoplasia and end-stage renal disease (ESRD).
RESUMEN
Introduction: Hemolytic uremic syndrome is the most frequent cause of acute renal failure in children, commonly after gastrointestinal infections with E. coli or Salmonella, and it is characterized by progressive renal failure associated with microangiopathic hemolytic anemia and thrombocytopenia. Cardiac involvement is frequently encountered and can be potentially fatal in hemolytic uremic syndrome. It is usually determined by overhydration, hypertension, anemia, diselectrolytemia, acid-base disorders and tendency to form thrombi, and it consists in the following conditions: pericarditis, myocardial infarction, dilated cardiomyopathy, cardiac failure, and arrythmias. Objective: The aim of this study is to observe the incidence of cardiovascular complications in children with acute hemolytic uremic syndrome, underline which are the most useful tools in establishing an accurate diagnosis, and discover the treatment protocol that has the most powerful impact upon the cardiovascular manifestations. Materials and methods: We studied a number of 50 children who checked in the Nephrology Department of "M. S. Curie" Emergency Clinical Hospital in Bucharest, Romania, between January 2016 and August 2020. We performed the clinical examination of all patients as well as several paraclinical tests such as electrocardiogram, transthoracic echocardiography, arterial blood pressure monitorization, and vascular Doppler ultrasound. Patients included in the study were aged between five and 40 months. Discussion and results: The majority of these children were diagnosed with arterial hypertension and some of them with cardiac failure and profound venous thrombosis. Transthoracic echocardiography revealed pathological aspects such as left ventricular hypertrophy, diastolic dysfunction, systolic dysfunction of the left ventricle, mitral regurgitation, aortic regurgitation, and pericarditis. Cardiac ultrasound findings were reversible in the majority of patients, most of them being treated with ACE inhibitors (eventually in association with other antihypertensive drugs).
RESUMEN
Introduction:Typical hemolytic uremic syndrome (HUS) is a leading cause of community acquired acute kidney injury in infants and young children. It is defined as a triad of microangiopathic hemolytic anemia, thrombocytopenia and renal insufficiency associated with Shiga toxin-producing Escherichia coli. In this case of HUS that we are going to present, hemolytic anemia and trombocitopenia were the major features, while renal involvement was less important. Case report:We report the case of a one-year-old Caucasian girl, without significant medical history, who was found to have stool culture with positive enteropathogenic Escherichia coli after an episode of diarrhea. The particularity of this case is that, even if the patient had prodromal diarrhea, thrombocytopenia and anemia in evolution, and the clinical features were consistent with typical HUS diagnosis, other diagnoses were considered due to the lack of apparent renal dysfunction. Conclusion:Our patient presented some, but not all, abnormalities seen in typical HUS, making it difficult to establish the final diagnosis. Providers must keep in mind to raise the suspicion of typical HUS diagnosis even when some symptoms are missing, in order to establish a correct diagnosis and initiate supportive care.
