Síndrome Urémico Hemolítico por Escherichia Coli productora de toxina Shiga en un paciente pediátrico con trasplante renal
Resumen
El Síndrome Urémico Hemolítico (SUH) secundario a la infección por Escherichia coli productora de toxina Shiga (STEC) serotipo O157:H7 es una enfermedad endémica en Argentina según la Organización Panamericana de la Salud, siendo en nuestro país, y en los niños la primera causa de Injuria renal aguda (IRA) y la segunda causa de Insuficiencia Renal Crónica (IRC). Esta entidad clínica y anátomo-patológica se caracteriza por presentación aguda de daño renal, anemia hemolítica microangiopática y trombocitopenia, que puede afectar otros parénquimas como intestino, sistema nervioso central, páncreas, corazón e hígado. Más del 90% de los pacientes afectados se recuperan en período agudo, aunque se han descrito secuelas renales a largo plazo hasta en el 25% de ellos. Según nuestro conocimiento aún no ha sido descrito en nuestro país casos de síndrome urémico hemolítico secundario a infección por Escherichia coli, productora de STEC luego del Trasplante Renal (TxR).
Citas
Rivas M, Miliwebsky E, Chinen I, Deza N, Leotta GA. Epidemiología del síndrome urémico hemolítico en Argentina. Diagnóstico del agente etiológico, reservorios y vías de transmisión. Medicina (B Aires) 2006;66(Supl. 3): 27-32.
Rivero MA, Padola Nora L, Etcheverria AI, Parma AE. Escherichia Coli enterohemorrágica y síndrome urémico hemolítico en Argentina. Medicina (B Aires) 2004;64(4):352-6.
Chaparro A, Monteverde M, Ibáñez J, Adragna M, López L, Briones L, et al. Trasplante renal 1988-2008. Medicina Infantil 2009;16(2):118-25.
Gianantonio C, Vitacco M, Mendilaharzu F, Rutty A, Mendilaharzu J. The hemolytic-uremic syndrome. J Pediatr 1964;64(4): 478-91.
Noris M, Remuzzi G. Hemolytic uremic syndrome. J Am Soc Nephrol. 2005;16(4):1035-50.
Spizzirri FD, Rahman RC, Bibiloni N, Ruscasso JD, Amoreo OR. Childhood hemolytic uremic syndrome in Argentina: long-term follow-up and prognostic features. Pediatr Nephrol. 1997;11(2):156-60.
Garg AX, Suri RS, Barrowman N, Rehman F, Matsell D, Rosas-Arellano MP, et al. Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA. 2003;290(10):1360-70.
De Souza VC, Rabilloud M, Cochat P, Selistre L, Hadj-Aissa A, Kassai B, et al. Schwartz formula: is one k-coefficient adequate for all children? PLoS One. 2012;7(12):e53439.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555-76.
Sis B, Mengel M, Haas M, Colvin RB, Halloran PF, Racusen LC, et al. Banff ‘09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups. Am J Transplant. 2010;10(3):464-71.
Green M. Introduction: Infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):3-8.
North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2014 Annual Transplant Report [citado 5 Oct 2015]. Disponible en: <https://web.emmes.com/study/ped/annlrept/annualrept2014.pdf>
Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol.
;23(10):1749-60.
Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study. J Infect Dis. 2002;186(4):493-500.
Orth D, Wurzner R. Complement in typical hemolytic uremic syndrome. Semin Thromb Hemost 2010;36(6):620-4.
Zoja C, Angioletti S, Donadelli R, Zanchi C, Tomasoni S, Binda E, et al. Shiga toxin-2 triggers endothelial leukocyte adhesion and transmigration via NFkappaB dependent up-regulation of IL-8 and MCP-1. Kidney Int. 2002;62(3):846-56.
Morigi M, Galbusera M, Binda E, Imberti B, Gastoldi S, Remuzzi A, et al. Verotoxin-1-induced up-regulation of adhesive molecules renders microvascular endothelial cells thrombogenic at high shear stress. Blood. 2001;98(6):1828-35.
Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol. 2008;23(10):1749-60.
Ferraris JR, Ramirez JA, Ruiz S, Caletti MG, Vallejo G, Piantanida JJ, et al. Shiga toxin-associated hemolytic uremic syndrome: absence of recurrence after renal transplantation. Pediatr Nephrol. 2002;17(10):809-14.
Noris M, Mescia F, Remuzzi G. STEC-HUS, atypical HUS and TTP are all diseases of complement activation. Nat Rev Nephrol. 2012;8(11):622-33.
Zheng XL, Sadler JE. Pathogenesis of thrombotic microangiopathies. Annu Rev Pathol. 2008;3:249-77.
Ruggenenti P, Noris M, Remuzzi G. Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney Int. 2001;60(3):831-46.
Amara U, Flierl MA, Rittirsch D, Klos A, Chen H, Acker B, et al. Molecular intercommunication between the complement and coagulation systems. J Immunol. 2010;185(9):5628-36.
Orth D, Khan AB, Naim A, Grif K, Brockmeyer J, Karch H, et al. Shiga toxin activates complement and binds factor H: evidence for an active role of complement in hemolytic uremic syndrome. J Immunol. 2009;182(10):6394-400.
Ehrlenbach S, Rosales A, Posch W, Wilflingseder D, Hermann M, Brockmeyer J, et al. Shiga toxin 2 reduces complement inhibitor CD59 expression on human renal tubular epithelial and glomerular endothelial cells. Infect Immun. 2013;81(8):2678-85.
Fang CJ, Fremeaux-Bacchi V, Liszewski MK, Pianetti G, Noris M, Goodship TH, et al. Membrane cofactor protein mutations in atypical hemolytic uremic syndrome (aHUS), fatal Stx-HUS, C3 glomerulonephritis, and the HELLP syndrome. Blood. 2008;111(2):624-32.
Le Quintrec M, Zuber J, Moulin B, Kamar N, Jablonski M, Lionet A, et al. Complement genes strongly predict recurrence and graft outcome in adult renal transplant recipients with atypical hemolytic and uremic syndrome. Am J Transplant. 2013;13(3):663-75.
Noris M, Remuzzi G. Thrombotic microangiopathy after kidney transplantation. Am J Transplant. 2010;10(7):1517-23.
Satoskar AA, Pelletier R, Adams P, Nadasdy GM, Brodsky S, Pesavento T, et al. De novo thrombotic microangiopathy in renal allograft biopsies-role of antibody-mediated rejection. Am J Transplant. 2010;10(8):1804-11.
Liptak P, Ivanyi B. Primer: Histopathology of calcineurin-inhibitor toxicity in renal allografts. Nat Clin Pract Nephrol. 2006;2(7):398-404.
