Hämolytisch-urämisches Syndrom im Kindes- und Jugendalter
Tóm tắt
Das hämolytisch-urämische Syndrom (HUS) ist definiert durch die Trias mikroangiopathische hämolytische Anämie, Thrombozytopenie und akute Nierenfunktionseinschränkung. Die häufigste Form im Kindesalter ist das STEC-HUS, bei dem eine Infektion mit shigatoxinproduzierenden Erregern zur hämorrhagischen Enterokolitis führt. In etwa 10 % der Fälle entsteht daraus ein HUS. Extrarenale Symptome können vorkommen. Die Diagnosesicherung erfolgt durch entsprechende Stuhl- bzw. serologische Diagnostik. Eine spezifische Therapie ist nicht möglich. Beim komplementvermittelten HUS kommt es durch Mutationen, Antikörperbildung und Trigger-Ereignisse zur Dysregulation im alternativen Weg der Komplementaktivierung. Aufgrund der spezifischen Therapiemöglichkeit mit dem C5-Inhibitor Eculizumab hat sich die Prognose deutlich gebessert. In seltenen Fällen lösen Infektionen (z. B. Pneumokokken) oder Grunderkrankungen (z. B. Cobalamin-C-Mangel) ein HUS aus. Aufgrund der Komplexität von Diagnostik und Therapie wird die Behandlung in einem kindernephrologischen Zentrum empfohlen.
Tài liệu tham khảo
AWMF Leitlinien. 166/002 S2k-Leitlinien; Hämolytisch-urämisches Syndrom im Kindesalter.
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