Abstract
Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. Here, we report the case of a 4.5-year-old boy with hemolytic-uremic syndrome and sudden onset, 6 h later, of hemodynamic compromise secondary to a cardiac thrombotic micro-angiopathy. The child died. In the literature, we found 18 further cases with cardiac compromise ≤25 days after diagnosis. The following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis.
Conclusion: We were able to document only 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise. Nonetheless, we speculate that a direct cardiac compromise accounts for many cases of childhood hemolytic-uremic syndrome complicated by sudden death during the initial hospitalization. Hence, we propose to always measure troponin in children with hemolytic-uremic syndrome to detect a latent myocardial damage.
What is Known: • Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. |
What is New: • This study documents 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise ≤ 25 days after diagnosis. • The Following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis. |
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abu-Arafeh I, Gray E, Youngson G, Auchterlonie I, Russell G (1995) Myocarditis and haemolytic uraemic syndrome. Arch Dis Child 72:46–47
Askiti V, Hendrickson K, Fish AJ, Braunlin E, Sinaiko AR (2004) Troponin I levels in a hemolytic uremic syndrome patient with severe cardiac failure. Pediatr Nephrol 19:345–348
Birk PE, Chakrabarti S, Lacson AG, Ogborn MR (1994) Cardiac tamponade as a terminal event in the hemolytic uremic syndrome in childhood. Pediatr Nephrol 8:754–755
Donoso Fuentes A, Arriagada Santis D, Bertrán Salinas K, Cruces Romero P, Díaz Rubio F (2010) Infarto de miocardio durante síndrome hemolítico urémico. An Pediatr (Barc) 72:362–363
Eckart P, Guillot M, Jokic M et al (1999) Atteinte cardiaque au cours du syndrome hémolytique et urémique typique. Arch Pédiatr 6:430–433
Machol K, Vivante A, Rubinsthein M, Dekel B, Danieli J, Paret G (2011) Keeping the heart in mind when managing hemolytic-uremic syndrome. Isr Med Assoc 13:446–447
Mohammed J, Filler G, Price A, Sharma AP (2009) Cardiac tamponade in diarrhoea-positive haemolytic uraemic syndrome. Nephrol Dial Transplant 24:679–681
Picard C, Burtey S, Bornet C, Curti C, Montana M, Vanelle P (2015) Pathophysiology and treatment of typical and atypical hemolytic uremic syndrome. Pathol Biol (Paris) 63:136–143
Poulton J, Taylor CM, De Giovanni JV (1987) Dilated cardiomyopathy associated with haemolytic uraemic syndrome. Br Heart J 57:181–183
Ray CG, Portman JN, Stamm SJ, Hickman RO (1971) Hemolytic-uremic syndrome and myocarditis. Association with coxsackievirus B infection. Am J Dis Child 122:418–420
Siegler RL (1992) Cardiovascular involvement in the hemolytic uremic syndrome. Kidney Dis 10:143–149
Thomas NJ, Messina JJ, DeBruin WJ, Carcillo JA (2005) Cardiac failure in hemolytic uremic syndrome and rescue with extracorporeal life support. Pediatr Cardiol 26:104–106
Thayu M, Chandler WL, Jelacic S, Gordon CA, Rosenthal GL, Tarr PI (2003) Cardiac ischemia during hemolytic uremic syndrome. Pediatr Nephrol 18:286–289
Tobias JD (2007) Hemolytic-uremic syndrome and myocardial dysfunction in a 9-month-old boy. Paediatr Anaesth 17:584–587
Upadhyaya K, Barwick K, Fishaut M, Kashgarian M, Siegel NJ (1980) The importance of nonrenal involvement in hemolytic-uremic syndrome. Pediatrics 65:115–120
Acknowledgments
We acknowledge the Fondazione E. Balli for the support and Drs. K. Daetwyler and B.S. Bucher for the collaboration in editing the manuscript. We acknowledge Prof. A. Perren, Institute of Pathology, University of Bern, for the histopathological help (Fig. 1).
Authors’ Contributions
All the above listed authors contributed substantially to the conception of the study, the acquisition of the raw data and its analysis and interpretation.
The initial manuscript has been consecutively edited for its scientific content and accuracy by all the listedauthors and the revised version has been approved to be published.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
For this type of study, formal consent is not required (systematic review of the literature). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Communicated by Mario Bianchetti
Rights and permissions
About this article
Cite this article
Rigamonti, D., Simonetti, G.D. Direct cardiac involvement in childhood hemolytic-uremic syndrome: case report and review of the literature. Eur J Pediatr 175, 1927–1931 (2016). https://doi.org/10.1007/s00431-016-2790-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-016-2790-y