Role of heparin therapy in the outcome of adult hemolytic uremic syndrome

Abstract

Intravenous heparin therapy was associated with complete recovery of renal function in a young woman who developed adult hemolytic uremic syndrome while taking oral contraceptive agents. No controlled study is yet available but a review of an additional 36 reported patients who fulfill adequate criteria for the diagnosis of adult hemolytic uremic syndrome suggests that consideration should be given to a trial of heparin therapy in patients with this syndrome in whom renal biopsy shows recoverable glomeruli in the presence of persistent severe impairment of renal function.

PIP: A case study of successful treatment of a 15-year-old white woman who developed adult hemolytic uremic syndrome following pregnancy and 14 months of oral contraception is given. She received iv infusion of heparin (750 units an hour continuously), later increased to 1000 units an hour. Following improvement, administration was changed to 8000 units 3 times daily sc. No immunosuppressive drugs, steroids, or antiplatelet agents were added. A review of the literature shows 37 patients with adequate evidence of diagnosis of acute renal failure due to hemolytic uremic syndrome. Only 3 were men. 13 of the women were wi thin 10 weeks postpartum and 9 were taking oral contraceptives. 62% died; 11% received regular dialysis. Details of therapy are not given in all cases but in 4 of 6 who received at least 1 week or adequate heparin therapy within 28 days after onset of the illness recovered. Although the drug can be dangerous, its use in such cases is indicated.