Case 19-2018: A 15-Year-Old Girl with Acute Kidney Injury




Patel, Nandeeta


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Atypical Hemolytic Uremic syndrome (aHUS) in children is a thrombotic microangiopathy which causes acute kidney injury (AKI), anemia, and thrombocytopenia. As compared to typical HUS caused by Shiga-Toxin producing E. Coli, atypical HUS may result from pregnancy, drugs, malignancy, or complement factor deficiency (most likely cause in this case). Case presentation: A 15-year-old Caucasian female presented to the hospital in the summer with 8 days of abdominal cramping, bloody diarrhea, vomiting, fatigue, and insomnia. She visited NYC for a few days and ate street food before experiencing symptoms. VS: T: 36.9°C, HR: 71 bpm, RR: 18, O2 Sat: 100%, BP: 124/75. She appeared mildly ill and pale on PE with tenderness in the upper abdomen and moderate ascites in the lower abdomen. Pmhx includes ADHD, anxiety, and labial adhesions. Patient's medications include citalopram and methylphenidate. Patient used ibuprofen with no relief of symptoms. Blood chemistry showed elevated BUN (97 mg/dl) and Creatinine (7.71 mg/dl)I, Sodium diminished at 132 mmol/liter, elevated AST/ALT, and elevated lipase. BUN/Creatinine ratio was 12.58. CBC showed diminished hemoglobin, decreased MCV, diminished haptoglobin, and thrombocytopenia. PBS showed anisocytosis, microcytosis, 1+ polychromasia, and enlarged platelets. Urinalysis was 3+ protein, 2+ blood and 20-50 RBC/HPF. Abdominal ultrasound showed mildly distended bladder, pelvic ascites, and abnormal contents in the gallbladder. Patient's stool cultures and antigen-detection tests were negative for causative organisms. Treatment included a meningococcal vaccine before receiving biweekly Eculizumab infusions for 6 months supported by 6 hemodialysis sessions and a blood transfusion.