Successful use of steroids in the management of two patients of diarrhea-associated adult hemolytic uremic syndrome

Abstract

Diarrhea-associated hemolytic uremic syndrome (HUS) occurs sporadically in the community. It is well known in the pediatric age group but also occurs in the adults, albeit with lower frequency. Prompt recognition of diarrhea-associated HUS is important, as it can be easily overlooked, as prerenal acute kidney injury. Besides this, management of diarrhea-associated HUS is different; varying from supportive care with meticulous observation for spontaneous recovery to occur, or to institute specific therapy such as plasmapheresis or immunosuppressant drugs, if it evolves into organ or life-threatening thrombotic microangiopathy (TMA). HUS is one type of TMA. Steroids have been used anecdotally either standalone or in combination with other therapies, in the management of TMA, especially if it is immune-mediated TMA. In our two cases of diarrhea associated TMA/HUS, we used steroids successfully as an empiric therapy for life threatening TMA.

Keywords

• acute kidney injury
• hemolytic uremic syndrome
• steroids
• thrombocytopenia
• thrombotic microangiopathy