Abstract: FR-PO1063

Fenoldopam in in Shiga Toxin-Related Hemolytic Uremic Syndrome

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Ardissino, Gianluigi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Consonni, Dario, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Giussani, Antenore, Fondazione IRCCS Cà granda policlinico Milano, Milano, Italy
  • Tel, Francesca, Fondazione Ca' Granda Osp. Maggiore Policlinico, Milano, Italy
  • Testa, Sara, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Paglialonga, Fabio, Fondazione Ca' Granda Osp. Maggiore Policlinico, Milano, Italy
  • Consolo, Silvia, Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy
  • Gandini, Cristiano, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
  • Napolitano, Luisa, Ospedale Maggiore Policlinico Cà Granda, San Donato Milan, Italy
  • Fossali, Emilio, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy
Background

The pathogenic sequence leading to renal damage in Shiga toxin-related hemolytic uremic syndrome (eHUS) includes endothelial injury, intravascular thrombi formation, microvascular occlusion and ischemic tissue injury. Early volume expansion (VE) reduces the number and severity of complication most likely by increasing organ perfusion. Fenoldopam (F), a dopamine-1 receptor agonist, is being widely used as an off-label treatment (T) for AKI as it induces renal vasodilation and favours perfusion, but we are unaware of its assessment in eHUS.

Methods

We describe our experience with F, in combination with VE, to treat 9 children with eHUS. FT was started immediately after eHUS was diagnosed. Renal resistance index (RRI) was measured on and off F. The disease course was compared with that observed in a cohort of patients receiving standard T(n=71) or early VE(n=66).

Results

Mean (SD) RRI decreased from 0.82(0.04) to 0.73(0.06) on F(-10.4%;p<0.00001). The figure compares the time-course of median serum creatinine during the initial 5 days of disease with the 3 T strategies, together with the platelet counts and the rate of RRT. An important reduction to 11.1% of the need of RRT was observed in patients treated with F(actually, a single patient required a single dialysis session) compared to either the standard T(59.1%) or the VE(34.9%) group. No patient treated with F showed signs of central nervous system involvement or any other complication and renal fuction quikly and fully recovered in all of them without sequels. No adverse event was observed.
Despite the clearly ongoing and severe thrombotic microangiopathy (as evidenced by platelets count), combined T with F and VE was associated with an impressive favourable outcome.

Conclusion

If confirmed on a larger scale, FT may become an important addition to VE for improving the outcome of eHUS with important lifesaving potentials.