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Anti-factor H antibody associated hemolytic uremic syndrome following SARS-CoV-2 infection
- Source :
- Pediatric Nephrology. September, 2022, Vol. 37 Issue 9, p2151, 6 p.
- Publication Year :
- 2022
-
Abstract
- Background The pathogenesis of autoantibody generation in anti-factor H (FH) antibody associated atypical hemolytic uremic syndrome (aHUS) is unknown and is perhaps triggered by an infectious or environmental agent. We observed an unusual increase of patients with anti-FH antibody associated aHUS coinciding with the second pandemic wave in New Delhi and suspected that SARS-CoV-2 infection might be a potential trigger. Methods We screened for SARS-CoV-2 infection using reverse transcriptase polymerase chain reaction (RT-PCR) and serology in 13 consecutive patients with anti-FH antibody associated aHUS during the past year in New Delhi. Results We report 5 patients, 4-13 years old, who presented with a febrile illness without respiratory symptoms during the second pandemic wave. Of these, 3 patients presented with a relapse 25-85 months following the initial episode of aHUS. SARS-CoV-2 was detected by RT-PCR in 1 patient and by serology in 4 patients (median titer 47.1 cut-off index). Patients had high titers of anti-FH antibodies (median 2,300 AU/ml). Genetic studies, done in 3 of the 5 patients, showed homozygous CFHR1 deletion without other significant genetic abnormalities. Specific management comprised plasma exchanges and oral prednisolone, combined with either cyclophosphamide or mycophenolate mofetil. At median follow-up of 3.3 months, the estimated glomerular filtration rate in 4 patients ranged from 62 to 110 ml/min/1.73 m.sup.2; one patient was dialysis-dependent. Conclusion Increased vigilance is required during the pandemic, especially in patients with anti-FH associated aHUS, who might relapse despite quiescent disease for a prolonged period. Graphical abstract<br />Author(s): Priyanka Khandelwal [sup.1] , Sudarsan Krishnasamy [sup.1] , Srinivasavaradan Govindarajan [sup.1] , Manish Kumar [sup.2] , Binata Marik [sup.1] , Aditi Sinha [sup.1] , Pankaj Hari [sup.1] , Arvind [...]
- Subjects :
- Hemolytic-uremic syndrome -- Risk factors -- Development and progression
Health
Subjects
Details
- Language :
- English
- ISSN :
- 0931041X
- Volume :
- 37
- Issue :
- 9
- Database :
- Gale General OneFile
- Journal :
- Pediatric Nephrology
- Publication Type :
- Academic Journal
- Accession number :
- edsgcl.711223003
- Full Text :
- https://doi.org/10.1007/s00467-021-05390-4