> Dear list members,
> we are in the process of rewriting our protocol for HUS. The use of
> plasma seems to be evident, but for other "nephroprotective" treatment
> there seems to be no evidence. Our nephrologists wish to adhere to the
> following protocol: * plasma 10ml/kg over 4h on three successive days
> * furosemide 1mg/kg initially, irrespective of diuresis, to be
> followed up according to diuresis * mannitol 1gr/kg, one single dose *
> dopamine 2 g/kg/min during 48h. I have to say, that our results in
> terms of need for dialysis or permanent renal insufficiency seem to be
> quite good, but of course we do not have a controlled study. I could
> not find literature on the protective effects (I do not speak about
> management of fluid balance and electrolytes) of furosemide, mannitol
> and dopamine alone or in combination in HUS patients. My questions to
> you all are:
> 1) what is your opinion/knowledge about the
> nephroprotective effect of furosemide, mannitol and dopamine in HUS;
> could you find reasons for a supra-additive effect of the combination
I am not aware of any such clinically proven effect in HUS.
Practically speaking, a diuretic early in the course of ARF could convert an
oliguric to a non oliguric renal failure making FEN management easier.
Theoretically, I could find reasons for the additive effect based on their
levels of action. Furosemide at the ascending loop of henle ( Cl channels),
mannitol as osmotic diuretic and dopamine at the renal vasculature.
> 2) do you yourself use any of these for HUS (irrespective of
> diuresis) ?
> 3) do you use other "protective" options or treatment
> (excluding the management of fluids and electrolytes) and what are
> your references for that treatment ?
> 4) what are your limits, at which
> you order a transfusion of blood or of platelets in HUS ?
Platelets only if CNS hemmorhage or invasive procedure planned. Tx
if anemia with failure/shock. Caution with both these issues because of
"fuel to the fire" and worsening of the duration + effects of
microangiopathy and delayed recovery.
> 5) how
> aggressive do you pursue adequate caloric intake in these children,
> who often have very poor appetite and tend to vomit a lot ?
Aggresive early parenteral nutrition management especially if acute
renal failure to reduce catabolic state and negative N2 balance.
> I will be very glad with any answers on a part or all of these
> questions; you may answer privately or on the list; if I get a lot of
> private input, I'll try to make a summary for the list.
I would be interested to hear your experience with plasma and
diuretics in HUS.
> Dr. Nikolaus Lutz-Dettinger
> Dept. of Intensive Care
> University Hospital Gent
> De Pintelaan 185
> B 9000 Gent
> tel.: **32 - 9 - 240 21 11
> fax: **32 - 9 - 240 49 95
> email: [log in to unmask]
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: